Deep Brain Stimulation in Parkinson’s Disease
Parkinson's disease is caused in part by loss of dopaminergic neurons in the substantia nigra pars compacta; the resultant abnormal neuronal oscillatory and synchronous activity between the subthalamic nucleus, globus pallidus interna, and cerebral cortex leads to increasing problems with tremor, rigidity, bradykinesia, and postural disturbances. Levodopa and other dopaminergic drugs relieve these movement disorders, but dyskinesia and motor fluctuations develop years later
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Deep brain stimulation is the surgical procedure of choice for patients with advanced Parkinson's disease. Neurosurgical procedures use electrical stimulation of small targets in the brain by use of a pacemaker-like device to deliver constant stimulation. Most neurosurgery for Parkinson's disease has been done on the thalamus, globus pallidus pars interna, or subthalamic nucleus. High frequency stimulation improves all cardinal features of PD, including resting tremor. This benefit in the parkinsonian symptoms allows a drastic reduction in daily levodopa requirements. Dyskinesias become drastically attenuated, possibly as a consequence of reduced dopaminergic medication, thus avoiding the problems associated with standard levodopa replacement therapy
