In Parkinson's disease, the globus pallidus is overactive, causing a decrease in the activity of another area of the brain that controls movement.  This overactivity leads to symptoms such as rigidity, movement disorders or tremors.

Pallidotomy

Pallidotomy is a surgical procedure developed in the 1950's for the treatment of the symptoms of Parkinson's disease. With the introduction of medical therapy for Parkinson's disease in the 1960's, this surgical procedure became less utilized. Recently, with improvements in technology, interest in pallidotomy has resumed.

In pallidotomy, the surgeon destroys a portion of the globus pallidus by creating a scar or lesion. This lesion interrupts this overactive nerve signal transmission of the globus pallidus, reducing the brain activity in that area, which may help relieve movement symptoms associated with Parkinson's disease, as well as treat rigidity and reduce tremor.

Thalmotomy

Thalamotomy is a similar procedure to pallidotomy, however, with this procedure, a small surgical lesion is created in the thalamus, which translates and relays information to areas of the cortex. The thalamus also plays an important role in regulating states of sleep and wakefulness.

Before pallidotomy is performed, a CT or MRI scan is conducted to help locate the area of the globus pallidus, the structure in the brain involved in the regulation of voluntary movements at a subconscious level.

The surgical procedure lasts about one hour and is completely painless. This is because the area of the brain begin operated on lacks pain receptors.

Most patients need to continue medications, though the medications may be reduced or be more effective for longer periods of time.

The patient's primary care physician is critical to this program, since that physician will be involved in adjusting the patient's medications and in overseeing the patient's routine health care needs.

Certain conditions may make pallidotomy inappropriate for certain patients. For example, patients with cognitive difficulties and memory problems, severe joint deformities or underlying medical conditions such as severe hypertension, multiple strokes or brain tumors may be at high risk for this procedure. Age itself is not an exclusionary factor, but patients over age 75 may have increased risk of complications (stroke/death) or may be less likely to respond to the procedure. Like pallidotomy, certain conditions may preclude patients from benefiting from Thalamotomy.

Pallidotomy is a procedure designed to treat symptoms but not cure Parkinson's disease.  However, in some cases the major symptoms of the disease are completely eliminated. And in most cases, the symptoms are alleviated.

Pallidotomy requires very little surgical time, lasting a total of four to five hours, including prep time. The procedure is completely painless and offers immediate relief. The treatment has also been shown to be effective for up to ten years.

Thalamotomy does not help some of the symptoms of Parkinson's disease, such as slowed movements.