Surgical Treatment
Brain surgery is an option for advanced PD patients whose symptoms can no longer be managed with medications.
Brain surgery is an option for advanced PD patients whose symptoms can no longer be managed with medications.
The best surgical candidate is someone who:
Advanced age is not necessarily a barrier to surgery, but some risk factors for the surgery that decreases the likelihood of an optimal outcome are:
Depending on the patient, procedure, and skill of the operating team, cognition may be mildly impaired or largely unaffected by the surgery. The most commonly reported adverse cognitive effects are reduced decision-making abilities and language impairments.
It is impossible to predict the benefit a patient can expect from the surgery. The general thumb rule is that the maximum benefit is equal to the best response from a dose of levodopa (minus the effect on dyskinesias). Therefore, if a patient's symptoms are 50% better at the peak of a levodopa dose, the surgery is not likely to improve the patient's symptoms more than that dose. Importantly though, improvements from surgery are most dramatic during the times the patient is not experiencing the effects of medications ("off" time). Therefore, surgery may greatly increase the time when symptoms are reduced.