J Korean Med Assoc.  2008 Feb;51(2):158-167. 10.5124/jkma.2008.51.2.158.

Surgical Treatment of Advanced Parkinson Disease

• Paek SH

• KMID: 2185733
• DOI: http://doi.org/10.5124/jkma.2008.51.2.158

Abstract

Parkinson disease (PD) is the second most common degenerative disease in the central nervous system following the Alzheimer's disease. Although the specific progressive degenerative change of dopamine-producing cells in the substantia nigra compacta has been well documented, neither the cause nor the underlying mechanism of degeneration has been identified. Long-term use of L-dopa causes dyskinesia, motor fluctuation, and other side effects, preventing the patients with advanced PD from further medication. Since deep brain stimulation (DBS) was introduced in the late 1980s by Dr. Benabid, it has become the standard surgical treatment for the patient with advanced PD who has developed drug-induced side effects or motor fluctuation after long-term use of L-dopa. Since DBS had been first reimbursed by the National Health Insurance System in January 2005 in Korea, many patients with advanced PD had a chance to be treated with DBS. The subthalamic nucleus (STN), globus pallidus interna (GPi), and thalamic VIM nucleus have been utilized as the target of DBS in the treatment of the patients with advanced PD. In this paper, the author briefly reviews the current methodology of surgical treatment of advanced PD, focusing on the STN DBS.

Keyword

Advanced parkinson disease; Subthalamic nucleus; Deep brain stimulation

MeSH Terms

Alzheimer Disease
Central Nervous System
Deep Brain Stimulation
Dyskinesias
Globus Pallidus
Humans
Korea
Levodopa
National Health Programs
Parkinson Disease
Substantia Nigra
Subthalamic Nucleus
Levodopa

Figure

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  Figure 1 Basal ganglia circuit in normal (A) and Parkison disease (B).

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  Figure 2 Parkinson diary example: The diary is divided into half-hour time periods on which patients denote whether they are on with nontroublesome dyskinesia, or on with troublesome dyskinesia. The patient or caregiver should place 1 check mark in each half-hour time slot to indicate the patient's predominant response during most of that period.

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  Figure 3 Frequent errors of asymmetries of frame placement.

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  Figure 4 Brain area to be covered in MRI in T2 axial images (left) and T1 axial images (right).

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  Figure 5 Simultaneous 5 channel microelectrode recording and record sheet.

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  Figure 6 Microelectrode recording during approach for subthalamic nucleus (SNr; substantia nigra pars reticulata, STN; subthalamic nucleus; Zi; zona incerta).

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