When drug therapies aren't doing enough for you, your doctor may suggest one of the various surgical procedures that have been known to have some success in treating Parkinson's, especially with motor disturbances.
There has been some success with the implantation in the brain of a device called 'The Activa'. This surgical procedure involves drilling through the skull, and implanting an electrode into the thalamus, which is the message relay center in the brain.
Next, a wire is run just under the scalp, down to the collarbone area, where a small "pulse generator" is implanted. This little pulse generator sends electrical waves, customized just for you, to the electrode. The Activa device blocks your tremors by sending out regular, small electrical impulses.
Before Levodopa came along, a fairly common surgical procedure called a 'pallidotomy' was used in the treatment of Parkinson's disease. This procedure has made a come-back thanks to a doctor from Sweden named Laitenen.
A Pallidotomy also involves drilling a tiny hole into the skull. And then, using data taken from a computer, a microelectrode is guided to a part of the brain where the overactive cells that are responsible for the tremors are located.
These overactive cells are destroyed when the microelectrode is used to burn a few small lesions in this area of the brain.
Only a local anesthetic is used, so if you were undergoing this surgery, you would be awake the whole time. The good news is you wouldn't experience any pain or discomfort.
Some patients on whom Laitenen performed pallidotomies described the results as 'miraculous'. They said they were able to walk again, and also that much or all of their tremors were gone.
Other patients did not experience such dramatic results. Most, however, did report improvement of some kind.
Following Laitenen's lead, other surgeons are now performing pallidotomies, as well.
A small region of the brain called the 'thalamus' is destroyed in a surgical procedure called 'thalamatomy'. This type of surgery has been effective for certain Parkinson's sufferers whose main difficulty with their disease is their tremors.
NEW THERAPEUTIC SURGICAL PROCEDURES
There is very active research going on in the field of Parkinson's treatments. Several surgical options have recently become available.
Deep Brain Stimulation This is a recent and very promising technique to control the tremors, and reduce some of the pain and postural rigidity associated with Parkinson's. It involves placing a permanent electrode in the region of the brain that produces the tremors.
The electrode is implanted deep in your brain, and is connected to a power source placed under the skin on your chest. The power can be adjusted as your symptoms dictate.
The downside of Deep Brain Stimulation is that the stimulatory device may need replacement because of fracture or infection, and the battery will need to be replaced surgically every three to five years.
Fetal Cell Transplantation In an effort to modify motor disability of advanced Parkinson's disease, fetal tissue from the mid-brain containing dopamine cells is implanted into a certain portion on both sides of the brain of the Parkinson's patient.
This procedure is still very experimental. The most recent study results really didn't show much promise. Patients who received the actual fetal cells and those who had sham surgery showed no difference.
Besides, the procedure is very labor intensive. Even if it is eventually shown to be effective, it will not become widespread, at least in the United States, because it requires such a large team of people to pull it off successfully.
Also, the numerous ethical issues associated with the use of human fetal cells will prevent it from becoming widely accepted.
However, there is much interest in using pig fetal cells to transplant into the human brain, and there are studies ongoing now around this.
A small number of patients have actually had the pig cells implanted, with mixed results. A few patients seemed to do quite well, while for others it didn't seem to do anything.
So far, we have no evidence that transplanting pig cells into the human brain transmits any pig viruses into humans, but that's a very big concern and is being looked at quite carefully by both neurologists and infectious disease experts.
Another large, long-term randomized controlled study using human fetal cells, sponsored by the National Institutes of Health, is currently in progress. However, results of this study will not be available for at least 2 years. Also being investigated is the use of stem cells (undeveloped cells).
There are a number and variety of these cells in certain parts of the human body, including the embryo, umbilical cord, and adult bone marrow.
They can be harvested and guided to develop into large numbers of dopamine-producing cells, and eventually they should be helpful in managing Parkinson's disease. Keep watching the study reports as they come out.
Currently, the number of people who undergo surgical treatments for Parkinson's is relatively small - less than 10% of patients (1000 patients) per year.
Most of them receive Deep Brain Stimulation (DBS) or ablative surgery. However, as techniques are improved, especially cell transplantation, more people are expected to choose and benefit from surgery.
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