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Surgical Treatment of Parkinson’s Disease

1 de March, 2024

In the vast majority of Parkinson’s disease patients, pharmacological treatment allows them to maintain an active and quality life for a long time. However, in some patients, motor complications can become difficult to treat, and surgical intervention should be considered. We share an opinion article from Professor Dr. Alexandre Mendes, a Neurologist at CNS Braga, in which he explains the benefits of surgical treatment and when it should be considered.

The diagnosis of Parkinson’s disease is clinical, made by a neurologist based on the symptoms and physical examination changes that the patient presents. Available treatment is symptomatic and significantly improves both motor and non-motor symptoms.

In the vast majority of patients, pharmacological treatment allows them to maintain an active and quality life for a long time. However, motor complications, motor fluctuations, and involuntary movements (dyskinesias) often arise after several years of treatment. Motor fluctuations correspond to the appearance, throughout the day, of periods when symptoms are well controlled alternating with periods when symptoms reappear. Medication adjustments can satisfactorily improve motor complications for more or less extended periods.

In some patients, especially when symptoms start at a younger age, motor complications can become difficult to treat, and surgical treatment should be considered.

The most commonly used surgical treatment is deep brain stimulation of the subthalamic nuclei. This technique was first used in Grenoble in 1993 and involves implanting brain electrodes connected to a stimulator implanted in the chest. This treatment significantly improved motor complications and medication-resistant tremor, gaining widespread acceptance and expansion. Patients who benefit the most are those who respond well to drug treatment but have motor complications causing disability. Criteria for surgery include, among others, no significant cognitive alterations, no uncontrolled psychiatric symptoms, and age under 70 years. In older patients, the benefit will be lower, and the risks higher.

For optimal benefit, electrode implantation must be very precise, and patient follow-up, with stimulation parameter adjustments and medication management, must be carefully performed by neurologists experienced in this treatment.

When patients have the appropriate characteristics, electrode implantation is ideal, and stimulation programming and medication management are adequate, they experience marked benefits. The times of day when symptoms are most pronounced tend to disappear, Parkinson’s medication is reduced, and dyskinesias decrease or disappear. Surgery also allows good tremor control, which is not always achieved with medication. It should be emphasized that surgical treatment does not alter the progressive course of the disease and that, differently, from patient to patient, symptoms resistant to various available treatments will appear.

Surgical treatment requires various tests and examinations, involves implanted material, and has risks, the main one being cerebral hemorrhage during the procedure, which is rare but can leave sequelae. For these reasons, this treatment is reserved for patients who are incapacitated for daily activities due to motor complications.

In summary, surgical treatment, among other available advanced treatments, allows a very significant improvement in patients with motor complications and disability. It is performed in centers with multidisciplinary teams and presupposes that the patient is well-informed and motivated.


Professor Dr. Alexandre Mendes

Neurologist and Movement Disorders Specialist

CNS – Campus Neurológico Braga