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Surgery has been used in the treatment of Parkinson’s disease for four decades. Recently it has revived in popularity as new, precise methods of brain surgery have made it more reliable and much safer. It is currently only available in specialist centres around the UK. There are four main approaches.

1. Thalamotomy
A tiny area in a part of the brain called the thalamus is destroyed using stereotaxic surgery. This operation is considered when tremor is disabling and interfering with everyday life to the extent that a person requires help with nearly all tasks. Every type of drug treatment will be tried first.

2. Pallidotomy
A tiny area in a part of the brain called the internal globus pallidus is destroyed using the same method as above. This operation is used to relieve severe dyskinesia, again only after every possible drug treatment has been tried.

3. Transplantation
Midbrain tissue from human foetuses can be transplanted into the diseased area of the brain of the person with Parkinson’s disease. These foetal cells then produce dopamine, which eventually relieves the symptoms of the disease. This operation is still in the experimental stages and has major ethical implications. Research is now being carried out to find out if animal tissue could be used instead. It may be possible that we will develop the technology in the future to make substantia nigra cells grow or regenerate using what are known as stem cells with trophic factors.

4. Deep brain stimulation
Instead of an area of the brain being permanently destroyed by stereotaxic surgery, a device called a deep brain stimulator is inserted. This uses the same
technology as heart pace makers, but sends rapid electrical impulses to specific
areas of the brain rather than the heart muscle. The stimulator can be placed in the thalamus, where it is most useful for treating tremor, or in the pallidum or subthalamus, where it is most effective for treating stiffness and dyskinesias. To date, subthalamic stimulators seem to be the most effective.

Radiosurgery
Radiosurgery is a new technique for treating disorders of the brain that is available in the UK in only a few specialised neurological centres.

The two main methods of carrying out radiosurgery are by gamma knife and by
modified linear accelerator (linac). Both of these procedures use a high energy dose of radiation that can be focused on a very precise point within the brain. Radiotherapy may require a number of visits over weeks or months, but radiosurgery is completed in one visit and usually does not require an overnight stay. This approach is sometimes used to treat deep-seated lesions or malformations within the brain that may be difficult to reach by conventional methods without causing damage.

Not all conditions are suitable for treatment by radiosurgery and the best individual course of action should be discussed with your doctor. To date, radiosurgery has produced disappointing results in the treatment of Parkinson’s disease.