Surgery for levodopa-induced dyskinesias

The effects of surgical interventions for levodopa-induced dyskinesias (LIDs) in Parkinson's disease are reviewed. Since the introduction of levodopa, thalamotomy has been reported to have variable effects on LIDs. Striking benefit has been demonstrated, and efficacy is probably dependent on the size and location of the lesion. However, it remains unclear whether it is an effective treatment for all types of LIDs. Currently, pallidotomy is probably the most reliable and effective surgical treatment for LIDs, and will continue to play an important role in its management until other treatments become more widely available. Deep brain stimulation is an extremely exciting mode of therapy, particularly in the subthalamic nucleus and the globus pallidus, and early results of its use in the treatment of LIDs are promising. The effects of cerebral transplantation, still an experimental technique, on LIDs are inconsistent and controversial, and there is little reliable evidence that gamma knife radiosurgery can be safely applied to parkinsonian patients for the treatment of LIDs.