Surgical management of Parkinson's disease

There has been a renaissance in the surgical treatment of Parkinson's disease (PD) over the last 15-20 years as a result of the long-term complications of L-DOPA use. The current cornerstone of surgical treatment for PD is high-frequency deep-brain stimulation (DBS) of the subthalamic nucleus (STN) using implantable electrodes and an implantable pulse generator/battery. Among well-selected patients, that is, patients with idiopathic PD, L-DOPA-responsive symptoms and no significant psychiatric comorbidities or cognitive decline, STN DBS can provide improvements in motor symptoms and quality of life, with low risks of adverse effects. In this article, we briefly describe the evolution of surgical treatments for PD, and the rationale for current DBS procedures. We also provide details of our practice, including patient selection, surgical technique and postoperative stimulation programming and medication adjustment. Current and possible future alternatives to DBS of the STN are also discussed.