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Surgical Treatment of Parkinson Disease
Emad N. Eskandar, MD;
G. Rees Cosgrove, MD,FRCSC;
Leslie A. Shinobu, MD,PhD
JAMA. 2001;286:3056-3059.
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INTRODUCTION
Several effective neurosurgical treatments for Parkinson disease (PD) have been developed based on an improved understanding of basal ganglia circuitry and the continuing evolution of neurosurgical techniques. Currently, there are 3 surgical targets for the treatment of movement disorders, the globus pallidus interna (Gpi), the subthalamic nucleus (STN), and the Ventralis intermedius nucleus of the thalamus. The Gpi and the STN are the preferred targets for the treatment of PD while Ventralis intermedius is now primarily targeted in the treatment of tremor. Options for treatment include the placement of a deep brain stimulating (DBS) electrode in any of these areas or the creation of a small lesion in the Gpi (pallidotomy) or in the thalamus (thalamotomy).
Surgery for Treatment of PD
Thalamotomy was introduced in the 1950s and was found to relieve tremor and rigidity, though bradykinesia was generally unaffected.1 During the same . . . [Full Text of this Article] Indications for Surgery Surgical Technique Thalamotomy and Thalamic Stimulation Pallidotomy and Pallidal Stimulation Subthalamic Stimulation
Transplantation
Conclusions
Author Affiliations: Departments of Neurosurgery (Drs Eskandar and Cosgrove) and Neurology (Dr Shinobu), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
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