Advances in the surgical treatment of Parkinson's disease and other movement disorders

Objective. To present the latest advances in surgery for patients with Parkinson's disease and other movement disorders, emphasizing pallidotomy and deep cerebral stimulation (DCS), thalamic, pallidal and subthalamic, their indications and complications. Development. Advances in neurophysiology and radiology have led to greater understanding of the physiology of the basal ganglia. This has led to the revival of old surgical techniques (pallidotomy) and the clinical application of new variants on these techniques. Pallidotomy is indicated inpatients with advanced Parkinson's disease who are under the age of 65 years and have no psychiatric complications or drug-induced debilitating dyscinesias. In most of these patients the daily dose of levodopa is reduced by approximately 30%. Any complications which occur are transient. The versatility of adjustment of the parameters of deep cerebral stimulation allow them to be adjusted to the patient's needs. Complications include transitory par aesthesia of the side contralateral to the stimulation, transitory tonic contraction of the face and limbs and in some cases dyskinesias which are similar to those induced by drugs. In the United States of America, the Food and Drugs Administration has authorized the use of thalamic DCS for treatment of essential/familial or Parkinsonian tremor of the hands. It is expected that by the end of this year pallidal-DCS will have been approved for the treatment of rigidify, tremor and bradykinesia in Parkinson's disease. Conclusion. Pallidotomy and DCS seem to be safe, useful techniques for the treatment of late complications of Parkinson's disease and possibly other movement disorders also.