Surgical treatments for Parkinson’s disease

Abstract

Parkinson’s disease (PD) is a progressive, incurable degenerative disease of the central nervous system, leading to a significant limitation of the functional state of patients. Modern medicine has several methods of medical and surgical treatment for this pathology. In the review, all stages of the surgical treatment of PD are considered, starting with the descriptions of the resection of the precentral gyrus of historical interest to stereotaxic lesions by various methods of exposure and electrical stimulation of the deep brain structures. The indications for each of the methods, their advantages and disadvantages, the principles of patient selection are presented. Indications for neurosurgical treatment are determined taking into account the international CAPSIT-PD criteria. Stereotactic lesions lead to irreversible changes in the medulla, therefore their widespread use is limited. Stimulation with deep electrodes has advantages in disease progression due to the possibility of changing the stimulation parameters and the possibility of a bilateral effect on motor symptoms. Surgical treatment of PD does not mean the cancelling of drug therapy, but it can reduce the dose of anti-Parkinsonian drugs and reduce their side effects. The best result can be achieved with timely operation and correct selection of patients by a multidisciplinary medical team with considering the characteristics of the course of the disease, the possibility of long-term postoperative observation of the patient and correction of stimulation parameters.