Your neurologist may suggest that you consider surgery if Parkinson's medication no longer controls your symptoms adequately,
What surgical treatments are available and what do they involve?
The most common surgical procedure is deep brain stimulation (DBS). This surgery has three possible surgical targets in the brain: the thalamus, the globus pallidum internus (GPi), and the subthalamic nucleus (STN).
DBS uses implanted electrodes to stimulate either the STN or the GPi. The electrical stimulation that these electrodes produce disrupts the abnormal brain activity which causes movement problems and so improves these symptoms. The stimulator can be adjusted or switched off as necessary.
For more information on other surgical techniques that are being researched, including Gene therapy and Stem cell (Cell replacement) therapy, see Surgical therapies.
Would I be suitable for surgery?
Your consultant or neurologist will be the best person to advise you. It is important that you discuss any questions and concerns you may have with a neurosurgeon if you are considering this option. You may also want to discuss the statistics of how many operations the surgeon has performed and the results that have been achieved.
A neurologist will consider many factors before determining if a patient is a good candidate, including their symptom control, their responsiveness to levodopa and their age.
The right time for DBS therapy is when your body no longer responds as well to medication as it used to, but before medication stops working completely. It is important to remember that if you wait too long, DBS will not be an option. DBS is not a last resort.
See also Surgical therapies.
Will Parkinson's surgery benefit me now and in the long term?
The main goal of surgery is to improve symptom control. Some symptoms may respond better than others. Your neurologist will be able to advise on this so make sure you discuss the potential benefits and weigh these up again possible risks. It is estimated that approximately 70% of those who have surgery experience a significant improvement.
Deep Brain Stimulation (DBS) can have very quick results and tremor can be seen to subside during the operation. DBS is adjustable and so the stimulation can be modified as Parkinson's progresses or your response to medications changes. Such modifications do not require further surgery.
DBS can be turned off at any time if side effects become a problem.
See also Surgical therapies.
Will surgery stop or alter how my disease progresses?
Surgical techniques have provided good symptom control in many cases, but it is important to remember that surgery is not a cure and it does not slow down the progression of Parkinson’s.
See also Surgical therapies.
Will surgery affect my usual activities?
Most activities can be continued after surgery although strenuous activity such as jogging or swimming should be left until at least six weeks so that wounds heal fully first. Contact sports such as rugby, football, and diving to depths of more than six metres, should be avoided.
Remember:
You should always tell your doctor and dentist about your surgery, as certain medical tests and scans should not be undertaken with some, but not all, DBS systems, i.e.
- diathermy (deep heat), including monopolar diathermy
- any therapy directed at the implantation site, including ultrasound, electrolysis, radiotherapy and electromagnetisation
- radiography which compresses the implantation area(s) (other radiographies are permitted)
- ultrasound for dental cleaning
- MRI scan
- cardiac defibriliation
- adrenalin should be administered with caution if local anesthesia is required.
See also Surgical therapies.
What are the disadvantages?
As with any surgical procedure there are risks, for example cognitive changes, speech problems and increased risk of stroke. These should all be discussed with your doctor in advance.
There is a 2-3% risk of a serious and permanent complication such as paralysis, seizure or infection, or changes in personality, memory and thinking. You also need to bear in mind that there are no guarantees that symptoms will improve after surgery, although in a majority of cases they do.
See also Surgical therapies.
Can I stop my medication after surgery?
Most people continue to take Parkinson’s medication after surgery, although sometimes the dose can be reduced. Your neurologist will be able to advise you on this and you should always discuss medication with your doctor before making any changes.
See also Managing medication.
Can I talk to someone who has already had surgery?
It can be very helpful to talk to someone who has already had the surgery you are considering. Talk to your neurologist if you would like to do so as they will usually be able to put you in contact with an appropriate person.
Would surgery be state funded? If not, how much does It cost?
The availability of surgical procedures on national health services varies from country to country, and even from region to region, so you will need to check locally. Make sure you also check on the provision of any follow-up care or further surgery that may be needed.
Costs vary from country to country so, again, you should check locally. Depending on the country you live in, some costs may or may not be paid by the state.
