This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (44)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Movement Disorders  • Parkinson Disease/ Parkinsonian Disorders  • Surgery  • Neurosurgery  • Alert me on articles by topic

A Critical Evaluation of the State of the Art

Anthony E. Lang, MD, FRCPC

Arch Neurol. 2000;57:1118-1125.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

There has been a marked resurgence of interest in surgical therapies for Parkinson disease (PD) in the past decade. This has been driven by the inexorable progression of the disorder that has been unaltered by available pharmacological therapy and the consistent occurrence of disabling motor complications, including fluctuations and dyskinesias, stemming from this treatment.

Many claims have been made regarding the efficacy of surgery for PD, but remarkably little evidence comes from properly designed controlled clinical trials. In this review, the available evidence for efficacy of the various surgical treatments offered to patients with PD (emphasizing lesions and deep brain stimulation [DBS]) will be summarized and the remaining uncertainties and unmet therapeutic needs will be discussed. A recent report¹ of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology evaluates surgery for PD.

Table 1 lists present and possible future surgical therapies . . . [Full Text of this Article]

GENERAL COMMENTS ON STUDY DESIGN ISSUES

ABLATIVE LESIONS OR DBS

Thalamus

Thalamotomy

Thalamic DBS

Globus Pallidus

Pallidotomy

Globus Pallidus DBS

Subthalamic Nucleus

Subthalamic Nucleotomy

STN DBS

TRANSPLANTATION

CONCLUSIONS

From the Department of Medicine, University of Toronto and Toronto Western Hospital, Toronto, Ontario.

RELATED ARTICLE

Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 2000;57(8):1241-1242.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Subthalamic nucleus stimulation modulates afferent inhibition in Parkinson disease
Sailer et al.
Neurology 2007;68:356-363.
ABSTRACT | FULL TEXT  

Stimulation of the subthalamic region facilitates the selection and inhibition of motor responses in Parkinson's disease.
van den Wildenberg et al.
J. Cogn. Neurosci. 2006;18:626-636.
ABSTRACT | FULL TEXT  

Treatments of Parkinson Disease: Circa 2003
Shults
Arch Neurol 2003;60:1680-1684.
ABSTRACT | FULL TEXT  

Parkinson's disease and anaesthesia
Nicholson et al.
Br J Anaesth 2002;89:904-916.
ABSTRACT | FULL TEXT  

Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson's disease
Loher et al.
J. Neurol. Neurosurg. Psychiatry 2002;73:395-399.
ABSTRACT | FULL TEXT  

Effects of subthalamic nucleus stimulation on motor cortex excitability in Parkinson's disease
Cunic et al.
Neurology 2002;58:1665-1672.
ABSTRACT | FULL TEXT  

Current State of Research on Decision-Making Competence of Cognitively Impaired Elderly Persons
Kim et al.
AJGP 2002;10:151-165.
ABSTRACT | FULL TEXT  

Clinical predictive factors of subthalamic stimulation in Parkinson's disease
Welter et al.
Brain 2002;125:575-583.
ABSTRACT | FULL TEXT  

Surgical Treatment of Parkinson Disease
Eskandar et al.
JAMA 2001;286:3056-3059.
FULL TEXT  

Surgery for Parkinson Disease and Other Movement Disorders: Benefits and Limitations of Ablation, Stimulation, Restoration, and Radiation
Jankovic
Arch Neurol 2001;58:1970-1972.
FULL TEXT  

Deep brain stimulation in the treatment of Parkinson's disease: A cost-effectiveness analysis
Tomaszewski and Holloway
Neurology 2001;57:663-671.
ABSTRACT | FULL TEXT  

Lesion of the Basal Ganglia and Surgery for Parkinson Disease
Obeso et al.
Arch Neurol 2001;58:1165-1166.
FULL TEXT  

Critical Evaluation of the State of the Art in Surgery for Parkinson Disease: Should We Use the Same Criteria as for Drug Trials?
Hariz and Lang
Arch Neurol 2001;58:315-316.
FULL TEXT