Surgical treatment of Parkinson's disease: ablation, stimulation and transplantation

Clinicians now have an extensive and effective pharmacopeia to treat the symptoms of Parkinson's disease - especially in the early and moderate stages of the disorder. Ultimately, a significant number of patients with the disorder find that, as their disease progresses, pharmacotherapy fails to control symptoms or produces unacceptable adverse effects as higher medication doses are used. For patients with Parkinson's disease whose symptoms are insufficiently controlled by medical therapy, surgical treatments can reduce symptoms, enhance functional capacity and sometimes reduce medication requirements. This article reviews the current state-of-the-art in surgical interventions for Parkinson's disease, with an emphasis on deep brain stimulation therapy, an evolving treatment that accomplishes symptom control in a reversible, adjustable and nondestructive manner.