Surgical treatments for Parkinson’s disease

Parkinson’s disease (PD) is a progressive, incurable degenerative disease of the central nervous system, leading to a significant limitation of the functional state of patients. Modern medicine has several methods of medical and surgical treatment for this pathology. In the review, all stages of the surgical treatment of PD are considered, starting with the descriptions of the resection of the precentral gyrus of historical interest to stereotaxic lesions by various methods of exposure and electrical stimulation of the deep brain structures. The indications for each of the methods, their advantages and disadvantages, the principles of patient selection are presented. Indications for neurosurgical treatment are determined taking into account the international CAPSIT-PD criteria. Stereotactic lesions lead to irreversible changes in the medulla, therefore their widespread use is limited. Stimulation with deep electrodes has advantages in disease progression due to the possibility of changing the stimulation parameters and the possibility of a bilateral effect on motor symptoms. Surgical treatment of PD does not mean the cancelling of drug therapy, but it can reduce the dose of anti-Parkinsonian drugs and reduce their side effects. The best result can be achieved with timely operation and correct selection of patients by a multidisciplinary medical team with considering the characteristics of the course of the disease, the possibility of long-term postoperative observation of the patient and correction of stimulation parameters.

1. Stock V.N., Levin O.S., Fedorova N.V. Extrapyramidal disorders. M.: MIA, 2002:235. (in Russian).

2. Bucy P.C. Surgical relief of tremor at rest. Ann. Surg. 1945;122:933–941.

3. Putnam T.J. Relief from unilateral paralysis agitans by section of the pyramidal tract. Arch. Neurol. Psychiatry. 1938;40:1049– 1050.

4. Abel T.J., Walch T., Howard M.A .III. Russell Meyers (1905–1999): pioneer of functional and ultrasonic neurosurgery. J. Neurosurg. 2016;125:1589–1595. https://doi.org/10.3171/2015.9.JNS142811

5. Speelman J.D., Bosch D.A. Resurgence of functional neurosurgery for Parkinson’s disease: A historical perspective. Movement Disorders. 1998;13(3):582–588. https://doi.org/10.1002/mds.870130336

6. Spiegel E.A., Wycis H.T. Pallidothalamotomy in chorea. Arch. Neurol. Psychiatry. 1950;64:295–296.

7. Spiegel E.A., Wycis H.T., Thur C. The stereoencephalotome (model III of our stereotaxic apparatus for operations on the human brain). J. Neurosurg. 1951;8:452–453.

8. Cooper I.S. Anterior choroidal artery ligation for involuntary movements. Science. 1953;118:193.

9. Bravo G.J., Cooper I.S. A clinical and radiological correlation of the lesions produced by chemopallidectomy and thalamectomy. J. Neurol. Neurosurg. Psychiatry. 1959;22:1–10.

10. Connolly B.S., Lang A.E. Pharmacological treatment of Parkinson disease: a review. JAMA. 2014;311:1670–1683. https://doi.org/10.1001/jama.2014.3654

11. Defer G.L., Widner H., Marié R.M., Rémy P., Levivier M. Core assessment program for surgical interventional therapies in Parkinson’s disease (CAPSIT-PD). Mov. Disord. 1999;14:572–84. https://doi.org/10.1002/1531-8257(199907)14:43.0.co;2-c

12. Extrapyramidal disorders yesterday, today, tomorrow. [Coll. art]. Ed. prof. O.S. Levin. 2nd ed. M., 2015:408. (in Russian).

13. Akhmetzhanov V.K., Shashkin Ch.S., Dzhamantaeva B.D. Parkinson’s disease. Pathophysiology of the extrapyramidal system. Modern ideas about the causes and pathogenesis of parkinsonism. Neurosurgery and neurology of Kazakhstan. 2016;2(43):44–51. (in Russian).

14. Schuurman P.R., Bosch D.A., Bossuyt P.M.M., Bonsel G.J., Someren E.J.W., Rob Bie M.A., et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N. Engl. J. Med. 2000;342:461–468. https://doi.org/10.1056/NEJM200002173420703

15. Bergman H., Wichmann T., DeLong M.R. Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science. 1990;249:1436–1438.

16. Aziz T.Z., Peggs D., Sambrook M.A., Crossman A.R. Lesion of the subthalamic nucleus for the alleviation of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism in the primate. Mov. Disord. 1991;6:288–292. https://doi.org/10.1159/000064599

17. Alvarez L., Macias R., Pavón N., López G., RodríguezOroz M.C., Rodríguez R. et al. Therapeutic efficacy of unilateral subthalamotomy in Parkinson’s disease: results in 89 patients followed for up to 36 months. J. Neurol. Neurosurg. Psychiatry. 2009;80(9):979–85. https://dx.doi.org/10.1136/jnnp.2008.154948

18. Vitek J.L., Bakay R.A., Freeman A., Evatt M., Green J., McDonald W. et al. Randomized trial of pallidotomy versus medical therapy for Parkinson’s disease. Ann. Neurol. 2003;53:558– 569. https://doi.org/10.1002/ana.10517

19. Eskandar E.N., Shinobu L.A., Penney J.B., Jr., Cosgrove G.R., Counihan T.J. Stereotactic pallidotomy performed without using microelectrode guidance in patients with Parkinson’s disease: surgical technique and 2-year results. J. Neurosurg. 2000;92:375– 383. https://doi.org/10.1159/000068960

20. Shannon K.M., Penn R.D., Kroin J.S., Adler C.H., Janko K.A., York M. et al. Stereotactic pallidotomy for the treatment of Parkinson’s disease. Efficacy and adverse effects at 6 months in 26 patients. Neurology. 1998;50:434–438. https://doi.org/10.1212/wnl.50.2.434

21. Rand R.W. Role of Cryosurgery and MRI for Parkinson’s Disease. Stereotact. Funct. Neurosurg. 1995;65(1–4):18–22. https://doi.org/10.1159/000098891

22. Koller W.C., Pahwa R., Lyons K.E., Albanese A. Surgical treatment of Parkinson’s disease. J. Neurol. Sci. 1999;167(1):1–10. https://doi.org/10.1016/S0022-510X(99)00139-2

23. Moosa S., Martínez-Fernández R., Elias W.J., Alamo M.D., Eisenberg H.M., Fishman P.S. The Role of High-Intensity Focused Ultrasound as a Symptomatic Treatment for Parkinson’s Disease. Mov. Disord. 2019;34(9):1243–1251. https://doi.org/10.1002/mds.27779. Epub 2019 Jul 10.

24. Ito H., Yamamoto K., Fukutake S., Odo T., Yamaguchi T., Taira T. Magnetic resonance imaging-guided focused ultrasound bilateral thalamotomy for essential tremor: A case report. Neurol. Clin. Neurosci. 2020;8(6):1–3. https://doi.org/10.1111/ncn3.12438

25. Alvarez L., Macias R., Pavon N., López G., RodríguezOroz M.C., Rodríguez R. et al. Therapeutic efficacy of unilateral subthalamotomy in Parkinson’s disease: results in 89 patients followed for up to 36 months. J. Neurol. Neurosurg. Psychiatry. 2009;80:979–985. https://doi.org/10.1136/jnnp.2008.154948

26. Krack P., Martinez-Fernandez R., Del Alamo M., Obeso J.A. Current applications and limitations of surgical treatments for movement disorders. Mov. Disord. 2017;32:36–52. https://doi.org/10.1002/mds.26890

27. Niranjan A., Lunsford L.D., Kano H. Leksell Radiosurgery for Movement Disorders. Leksell Radiosurgery. Prog. Neurol. Surg. Basel, Karger, 2019;34:279–288. https://doi.org/10.1159/000493075

28. Duma C.M. Movement disorder radiosurgery — planning, physics and complication avoidance. Prog. Neurol. Surg. 2007;20:249–266. https://doi.org/10.1159/000100168

29. Young R.F., Li F., Vermeulen S., Clayton D.A., Hesselgesser R.D. Gamma Knife pallidotomy for treatment of Parkinson’s disease: long term results, clinical study. Transl. Cancer Res. 2014;3:342–350. https://doi.org/10.3978/j.issn.2218-676X.2014.08.04

30. Cooper I.S. A Cryogenic Method for Physiologic Inhibition and Production of Lesions in the Brain. J. Neurosurg. 1962;19:853– 8. https://doi.org/10.3171/jns.1962.19.10.0853

31. Kandel E.I. Functional and stereotactic neurosurgery. M.: Medicine, 1981:368 p. (in Russian).

32. Charles A., Fager M.D. Use of the Radio-Frequency Electrode in Stereotactic Surgery of Parkinson’s Disease. Surgical Clinics of North America. 1965;45(3):705–713. https://doi.org/10.1016/s0039-6109(16)37593-4

33. Watkins E.S. Heat Gains in Brain During Electrocoagulative Lesions. J. Neurosurg. 1965;23(3):319–28. https://doi.org/10.3171/jns.1965.23.3.0319

34. Schreglmann S.R., Krauss J.K., Chang J.W., Bhatia K.P., Kägi G. Functional Lesional Neurosurgery for Tremor: A Systematic Review and Meta-Analysis. J. Neurol. Neurosurg. Psychiatry. 2018;89(7):717–726. https://doi.org/10.1136/jnnp-2017-316302. Epub 2018 Jan 11.

35. Ohye C., Higuchi Y., Shibazaki T., Hashimoto T., Koyama T., Hirai T. et al. Gamma Knife thalamotomy for Parkinson disease and essential tremor: a prospective multicenter study. Neurosurgery. 2012;70:526–536. https://doi.org/10.1227/NEU.0b013e3182350893

36. Young R.F., Jacques S., Mark R., Kopyov O., Copcutt B., Posewitz A. et al. Gamma Knife thalamotomy for treatment of tremor: long-term results. J. Neurosurg. 2000;93(Suppl.3):128–135. https://doi.org/10.3171/jns.2000.93.supplement

37. Kooshkabadi A., Lunsford L.D., Tonetti D., Flickinger J.C., Kondziolka D. Gamma Knife thalamotomy for tremor in the magnetic resonance imaging era. J. Neurosurg .2013;118:713–718. https://doi.org/10.3171/2013.1.JNS121111

38. Niranjan A., Kondziolka D., Baser S., Heyman R., Lunsford L.D. Functional outcomes after Gamma Knife thalamotomy for essential tremor and MS-related tremor. Neurology. 2000;55:443–446. https://doi.org/10.1212/wnl.55.3.443

39. Campbell A.M., Glover J., Chiang V.L., Gerrard J., Yu J.B. Gamma Knife stereotactic radiosurgical thalamotomy for intractable tremor: a systematic review of the literature. Radiother. Oncol. 2015;114:296–301. https://doi.org/10.1016/j.radonc.2015.01.013

40. Okun M.S., Stover N.P., Subramanian T., Gearing M., Wainer B.H., Holder C.A. et al. Complications of gamma knife surgery for Parkinson disease. Arch. Neurol. 2001;58:1995– 2002. https://doi.org/10.1001/archneur.58.12.1995

41. Witjas T., Carron R., Krack P., Eusebio A., Vaugoyeau M., Hariz M. et al. A prospective single-blind study of Gamma Knife thalamotomy for tremor. Neurology. 2015;85:1562–1568. https://doi.org/10.1212/WNL.0000000000002087

42. Moser D. MR-guided focused ultrasound technique in functional neurosurgery: targeting accuracy. J. Ther. Ultrasound. 2013;1:3. https://doi.org/10.1186/2050-5736-1-3

43. Christian E., Yu C., Apuzzo M.L. Focused ultrasound: relevant history and prospects for the addition of mechanical energy to the neurosurgical armamentarium. World Neurosurg. 2014;82:354– 365. https://doi.org/10.1016/j.wneu.2014.06.021

44. Fry W.J., Mosberg Jr.W.H., Barnard J.W., Fry F.J. Production of focal destructive lesions in the central nervous system with ultrasound. J. Neurosurg. 1954;11:471–478. https://doi.org/10.3171/jns.1954.11.5.0471

45. Jagannathan J., Sanghvi N.T., Crum L.A., Yen C.-P., Medel R., Dumont A.S. et al. High-intensity focused ultrasound surgery of the brain: part 1 — a historical perspective with modern applications. Neurosurgery 2009;64:201–210;discussion,210–211. https://doi.org/10.1227/01.NEU.0000336766.18197.8E

46. Gallay M.N., Moser D., Jeanmonod D. Safety and accuracy of incisionless transcranial MR-guided focused ultrasound functional neurosurgery: single-center experience with 253 targets in 180 treatments. J. Neurosurg. 2018;May 1. https://doi.org/10.3171/2017.12.JNS172054

47. Bond A.E., Shah B.B., Huss D.S., Dallapiazza R.F., Warren A., Harrison M.B. et al. Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremordominant Parkinson disease: a randomized clinical trial. JAMA Neurol. 2017;74:1412–1418. https://doi.org/10.1001/jamaneurol.2017.3098

48. Jung N.Y., Rachmilevitch I., Sibiger O., Amar T., Zadicario E., Chang J.W. Factors Related to Successful Energy Transmission of Focused Ultrasound through a Skull: A Study in Human Cadavers and Its Comparison with Clinical Experiences. J. Korean Neurosurg. Soc. 2019;62(6):712–722. https://doi.org/10.3340/jkns.2018.0226

49. Mazerolle E.L., Seasonsa G.M., Warwaruk-Rogers R., Romo P., Nordal R., Sevick R.J. et al. Focused ultrasound resolves persistent radiosurgery related change in a patient with tremor. Radiology Case Reports. 2019;14(10):1233–1236. https://doi.org/10.1016/j.radcr.2019.07.010

50. Zalyalova Z.A. Deep brain stimulation. How does she control movement in Parkinson’s disease? Neurosurgery. 2019;21(3):93–99. (in Russian). https://doi.org/10.17650/1683-3295-2019-21-3-93-99

51. Benazzouz A., Hallett M. Mechanism of Action of Deep Brain Stimulation. Neurology. 2000;55(12Suppl.6):S13–6. PMID: 11188968.

52. Tomskiy A.A., Bril E.V., Gamaleya A.A., Fedorova N.V., Levin O.S. Functional neurosurgery for Parkinson’s disease in Russia. Annals of Clinical and Experimental Neurology 2019;13(4):10–15. (in Russian). https://doi.org/10.25692/ACEN.2019.4.2

53. Follett K.A., Weaver F.M., Stern M., Kwan Hur, Harris C.L., Luo P. et al. Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease. N Engl J. Med. 2010;362:2077–2091. https://doi.org/10.1056/NEJMoa0907083

54. Voon V., Kubu C., Krack P., Houeto J.-L., Tröster A.I. Deep brain stimulation: Neuropsychological and neuropsychiatric issues. Mov. Disord. 2006;21Suppl.14:S305 — 27. https://doi.org/10.1002/mds.20963

55. Vendette M., Gagnon J.-F., Decary A., Massicotte-Marquez J., Postuma R.B., Doyon J. et al. REM sleep behavior disorder predicts cognitive impairment in Parkinson’s disease without dementia. Neurology. 2007;69(19):1843–9. https://doi.org/10.1212/01.wnl.0000278114.14096.74

56. Charles P.D., Dolhun R.M., Gill C.E., Davisa T.L., Blitonc M.J., Tramontanad M.G. et al. Deep brain stimulation in early Parkinson’s disease: Enrollment experience from a pilot trial. Parkinsonism & Related Disorders. 2012;18(3):268–273. https://doi.org/10.1016/j.parkreldis.2011.11.001

57. Schuepbach W.M., Rau J., Knudsen K., Volkmann J., Krack P., Timmermann L. еt. al. EARLYSTIM Study Group. Neurostimulation for Parkinson’s disease with early motor complications. The New England Journal of Medicine. 2013;368(7):610–22. https://doi.org/10.1056/NEJMoa1205158

58. Lhommée E., Wojtecki L., Czernecki V., Witt K., Maier F., Tonder L. et al. EARLYSTIM study group. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson’s disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial. The Lancet Neurology. 2018;17(3):223–31. https://doi.org/10.1016/S1474-4422(18)30035-8

59. Greb E. Can DBS in Early Parkinson’s Disease Reduce Disease Progression? Medscape. 2020;Jul 09. https://www.medscape.com/viewarticle/933676#vp_1

60. Bril E.V. Early neurostimulation of the subcortical structures of the brain in Parkinson’s disease. The controversy continues. Bulletin of the National Society for the Study of Parkinson’s Disease and Movement Disorders. 2020;3:13–15. (in Russian). https://doi.org/10.24412/2226-079X-2020-12236