Surgical Treatment And Preparation For Surgery For Parkinson

Surgery is typically considered only after medicine and other treatments have been exhausted and are no longer of benefit to the patient.

Surgical treatment for Parkinson’s disease was first developed over 50 years ago. There are new developments such as deep brain stimulation (DBS) that was developed in the 1990s and has since become standard treatment for the disease. Individuals who have disabling tremors, or who experience “wearing-off” or medication-induced dyskinesias deep brain stimulation can be very effective.

Electrodes are inserted into the targeted part of the brain during deep brain stimulation surgery. An MRI and neurophysiological mapping is used to assist the surgery sot hat the electrode is implanted in the correct place within the brain.

Before undergoing any surgery, the patient should be given all the information necessary regarding the surgery, the risks involved and the benefits of the surgery before making any decisions regarding having the surgery.

There are many factors that the neurologist will use to evaluate the appropriateness of surgery including the diagnosis of idiopathic Parkinson’s disease, the positive response the patient had to levodopa, the absence of atypical features of Parkinson’s, any presence of advanced disease, age (younger than 75), normal cognitive ability, absence of active psychiatric disease, and also good social support.

The surgeon makes an evaluation as to which procedures may be of benefit to the patient, and has close collaboration with the neurologist. The decision-making process may involve the surgeon and the neurologist as well as the patient or patient’s caregiver.

Once the decision is made to have the surgery a workup is conducted that may include the following:

A brain MRI in order to rule out other conditions and to find out the degree of brain atrophy. If there is a significant amount of atrophy it would increase the risk for perioperative hemorrhage.

Neuropsychological testing will be conducted in order to rule out cognitive impairment, which may be worsened during the surgical procedure.

A psychiatric evaluation may be ordered so that active psychiatric disease can be ruled out and any past psychiatric history can be evaluated.

A fluorodopa PET scan to rule out multiple system atrophy.

Lastly, a medical examination will be done so that the general health of the patient can be determined prior to surgery in order to determine if the patient is fit for surgery.

The purpose of surgery is for management of the symptoms of Parkinson’s disease and to promote better quality of life. Surgery is not a cure for Parkinson’s and is not a preventative for the progressive nature of the disease.

Your doctor will go over all of the surgical procedures offered for Parkinson’s along with the projected benefits, and the risks that are associated with each of the procedures. It is possible that there may be multiple surgeries that will be necessary in order to manage the disease as the years go by.

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