Kelly E Lyons and Rajesh Pahwa

The Parkinson's-Reversing Breakthrough

Medication for Parkinson Disease

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Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.

Stereotactic surgeries for movement disorders were introduced in the late 1940s (1-3) but were not widely accepted due to significant morbidity, mortality, and limited knowledge of the appropriate target for symptomatic benefit. With advances in pharmacological therapy, particularly the availability of levodopa, these surgeries were rarely performed for Parkinson's disease (PD) until the late 1980s (4). Based on the limitations of drug treatments for PD, and a better understanding of the physiology and circuitry of the basal ganglia there has been a marked increase in the use of surgical treatments for PD. In addition, advances in surgical techniques, neu-roimaging, and improved electrophysiological recordings allow stereotactic procedures to be done more accurately leading to reduced morbidity. Deep brain stimulation (DBS) has largely replaced lesion surgery as the preferred procedure for PD. There are currently three targets for DBS in PD: the ventral intermediate (VIM) nucleus of the thalamus, the globus pallidus interna (GPi), and the subthalamic nucleus (STN).

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