Surgical insights into Parkinson's disease

Abstract

Surgery for Parkinson's disease was popularized in the mid-twentieth century before the advent of effective medical therapies. Early lesioning treatments contributed to our understanding of the functional anatomy of Parkinson's disease. Observations of the limitations and long-term complications of established pharmacological therapies for Parkinson's disease, together with major contributions from animal research to elucidate the roles of the basal ganglia in movement disorders, inspired a recent renaissance in neurosurgical interventions for Parkinson's disease including deep brain stimulation; this continues to yield much neurophysiological information. The development of potentially restorative treatment modalities, such as gene therapy, neural transplantation and nanotechnology, hold much promise for surgery, both therapeutically and in revealing further insights into Parkinson's disease pathophysiology.

Figure 1

A coronal section through a cerebral hemisphere illustrating the basal ganglia. STR, striatum; GPe, globus pallidus pars externa; GPi, globus pallidus pars interna; Th, thalamus; subthalamic nucleus; STN, subthalamic nucleus; SNr, substantia nigra pars reticulata; SNc, substantia nigra pars compacta [in colour online]

Figure 2

Basal ganglia circuitry involved in movement. GPe, globus pallidus pars externa; GPi, globus pallidus pars interna; STN, subthalamic nucleus; SNc, substantia nigra pars compacta; SNr, substantia nigra pars reticulata; VL, ventrolateral thalamus; PPN, pedunculopontine nucleus [in colour online]

Figure 3

Electrode implantation for deep brain stimulation in Parkinson's disease [in colour online]