SURGERY FOR MOVEMENT
DISORDERS
Philip A. Hanna, MD
Parkinson's Disease and Movement Disorders Center
New Jersey Neuroscience Institute
Edison, New Jersey
A number of different movement disorders, particularly Parkinson's
disease (PD), essential tremor (ET) and certain forms of dystonia may
benefit from surgery. The types of surgery available include 1.
Pallidotomy which involves lesioning (destruction) of the globus
pallidus, a small area of the brain which is overactive in patients
with PD and dystonia. 2. Thalamotomy in which a different area of the
brain (thalamus) involved in tremor, is lesioned. 3. Deep brain
stimulation, where an electrical "pacemaker" device delivers
high-frequency stimulation to a target in the brain, thus effectively
jamming the electrical activity at the target site. 4. Transplantation
of cells with the goal of replacing cells that are dying.
Other procedures surgeries such as cutting nerve roots in the neck
(for dystonia), stimulation of the vagus nerve to suppress tremor, or
placing catheters over the spinal cord to deliver medications such as
baclofen to relieve spasticity are also used. In addition, gamma knife
radiosurgery is being investigated at the NJ Neuroscience Institute
for its potential use in movement disorders.
Pallidotomy has been used for a number of years in PD and more
recently for dystonia, particularly the generalized forms. In PD,
pallidotomy is most helpful in the alleviation of dyskinesias
(drug-induced involuntary movements), but is also quite useful in the
other cardinal features of PD such as tremor, slowness of movement and
stiffness. Deep brain stimulation is discussed more fully in the
information packet regarding this procedure. Fetal cell transplants
for PD are still quite experimental with porcine transplants being
investigated more recently.
With regards to insurance coverage, most insurance companies,
including Medicare, will cover the payments for pallidotomy and
thalamic DBS. Patients are first evaluated by a neurologist in the
movement disorders section (Drs. Philip Hanna, Arthur Walters, or
Timothy Brannan). All surgeries are performed at JFK medical center by
the neurosurgical team, led by R.A. Zappulla, MD, PhD. Most procedures
last 3-6 hours and the typically hospital stay may last from 2-7 days.
Ondo W, Jankovic J, Schwartz K, Almaguer M, Simpson RK. Unilateral
thalamic deep brain stimulation for refractory essential tremor and
Parkinson's disease tremor. Neurology 1998;51:1063-1068.
Pollak P, Benabid AL, Krack P, Limousin P, Benazzouz A. Deep brain
stimulation. In: Jankovic J, Tolosa E, eds. Parkinson's Disease and
Movement Disorders, 3rd edition, Williams and Wilkins, Baltimore,
Maryland, 1998:1085-1102.
Hanna PA, Cardoso F, Jankovic J. Basal Ganglia and Movement Disorders.
In: Rolak LA, ed. Neurology Secrets, 2nd ed. New York: Hanley and
Belfus, 1998:137-169.
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