James Beck 00:00:04
Hi, my name is Dr. Jim Beck. I'm the Chief Scientific Officer of the Parkinson's Foundation, and on this episode of NeuroTalk, I'm going to talk about surgical procedures for Parkinson's disease.
There are several surgical treatment options for people with Parkinson's disease. This is an option that usually is applied to people who've exhausted current medical treatments, who are experiencing motor fluctuations or who are under the advisement of their neurologist to pursue these treatment options. These treatment options include deep brain stimulation surgery, Duopa, which is a surgical treatment in the gut, or lesioning surgery. Those are the broad categories.
James Beck 00:00:48
With deep brain stimulation surgery, a fine wire electrode is placed into the brain, and it provides a pacemaker-like activity, electrical input to the brain to help control many of the motor symptoms with Parkinson's disease. After the wire is implanted in the brain, there's often a second surgical procedure to implant the pacemaker, if you will, the impulse generator, into the chest of a person with Parkinson's disease. After the surgery has been conducted, a surgeon will then program the device in order to provide the benefit for a person with Parkinson's disease.
Deep brain stimulation surgery is not for everyone, and people have to go through an extensive process to ensure that they're qualified for this surgical procedure. One caveat to keep in mind about this surgical treatment is that it really can only help the symptoms that levodopa will help for Parkinson's disease. It will not cure Parkinson's disease.
Another surgical treatment option for people with Parkinson's disease is called Duopa therapy. A surgical procedure is done with a small incision in the abdomen to insert a tube through the stomach into the small intestine. Through this tube, levodopa-carbidopa in a gel form is delivered to help control the symptoms of Parkinson's disease.
James Beck 00:02:01
Again, this is levodopa-carbidopa, so it provides symptom relief much like oral forms of levodopa will provide, but it provides it in a continuous fashion. It minimizes off times and provides a consistent blood level of levodopa to help control symptoms for people with Parkinson's disease.
What is interesting about Duopa therapy is that it can be combined with deep brain stimulation surgery as well. Someone who's had DBS can get Duopa therapy, and someone who's had Duopa therapy can also undergo deep brain stimulation surgery as necessary. Because it doesn't involve surgery in the head, some people find it more appealing to have a surgical procedure in the gut.
Another type of surgical therapy for people with Parkinson's disease is called lesion therapy. Lesion therapy was developed in the 1950s as a way to control some of the symptoms of Parkinson's disease. Lesion therapy means that typically what happens is a fine needle is inserted into the brain of a person with Parkinson's disease, and that needle either is super cold or super hot and damages part of the brain, actually burns away some of the brain tissue.
James Beck 00:03:13
That's often used to control some of the tremor symptoms of Parkinson's disease. A more modern incarnation of lesion therapy is focused ultrasound therapy. It doesn't involve an overt surgical procedure, but nevertheless, it's an invasive procedure that is able to produce a similar effect using focused ultrasound waves. These waves are focused to a fine point into someone's brain and utilized to heat up the brain tissue to lesion it in order to control some of the symptoms of Parkinson's disease.
The downside of lesion therapy is that it's typically not adjustable, whereas deep brain stimulation surgery, if the stimulation isn't working effectively, a neurologist can adjust it. With lesion therapy, you don't have those kinds of options available with which to make adjustments. Lesion therapy also is a one-way therapy. You can't put the brain tissue back once it's been ablated.
Learn more about surgical options for Parkinson's disease at our online educational library at Parkinson.org/library.
