Surgery for Parkinson's disease

• bilateral subthalamic nucleus stimulation or bilateral globus pallidus interna stimulation may be used in people with PD who:
  • have motor complications that are refractory to best medical treatment,
  • are biologically fit with no clinically significant active comorbidity,
  • are levodopa responsive and
  • have no clinically significant active mental health problems, for example, depression or dementia
• with the current evidence it is not possible to decide if the subthalamic nucleus or globus pallidus interna is the preferred target for deep brain stimulation for people with PD, or whether one form of surgery is more effective or safer than the other.

Patient-controlled high frequency stimulation of the thalamus may control tremor.

• thalamic deep brain stimulation may be considered as an option in people with PD who predominantly have severe disabling tremor and where STN stimulation cannot be performed

Transplantation of foetal substantia nigra tissue is an experimental therapy.

Reference:

1. Parkinson’s Disease.National clinical guideline for diagnosis and management in primary and secondary care. NICE full guideline.2006 http://www.nice.org.uk/