Who is a candidate for Parkinson’s disease Surgery?
Patient refractory to medical management :
Parkinson’s disease surgery is only appropriate for Parkinson’s disease patients who were initially responsive to Levodopa but have either developed side effects or are poorly controlled at the present time.
Before considering surgical therapy, it is very important to note that the diagnosis of the Parkinson’s disease should be confirmed unequivocally. There are various diseases that can present with “Parkinsonian” symptoms. This includes Multiple System Atrophy (MSA), Cortico Basal Ganglionic Degeneration (CBGD), Progressive Supra-Nuclear Palsy (PSP), etc. The best way to confirm the diagnosis of Parkinson’s disease is to be examined by a clinician who is skilled in movement disorders. Another way of confirming this is the assessment of response to Levodopa treatment. Patients who respond dramatically to Levodopa treatment, even though for a short time, are more likely to be suffering from Parkinson’s disease than any other disease.
Prototypical candidate for Parkinson’s disease surgery :
Patient would have been suffering from PD for more than five years. In recent times he may have started experiencing shortening of On period (period of relief from symptoms after taking medicines), ON periods associated with involuntary dancing like movements hallucinations, off period pain etc. These symptoms only can only be partially be controlled with medications, leaving patient miserable or handicapped.
The following symptoms respond dramatically by DBS
- Off period pain
- Motor fluctuations
Patients who are not satisfied with their present medical management should consider exploring surgical option