Surgery becomes a treatment option for people who have Parkinson’s disease, when their symptoms are no longer adequately controlled by medication. Each person experiences different symptoms and each person tolerates both symptoms and medication differently. For one person, advanced disease may worsen symptoms beyond medication control, suggesting surgical intervention. For another, quality of life or job-related issues may necessitate surgery in an earlier stage. There is no right or wrong time to consider surgery, though there are indications against surgery, including other serious illnesses (i.e., some cardiac disease or pulmonary disease) or Parkinson’s dementia.
Though thalamotomy and pallidotomy are still performed for Parkinson’s disease in certain situations, deep brain stimulation is now the surgery of choice. Specifics of each patient’s symptoms typically guide the choice of target in the brain for implantation of a deep brain stimulator. Most often, the subthalamic nucleus (STN) or globus pallidus internus (GPi) are the targets used to treat Parkinson’s disease symptoms. Whether electrodes are implanted on one or both sides of the brain (in two separate surgeries, if on both sides) will be determined by whether or not symptoms are equally severe on both sides of the body. DBS most often provides significant improvement in symptom control and allows welcome reduction in medication.