Surgical treatment of dyskinesia in Parkinson’s disease
- 1Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada
- 2Neuroimaging Unit, Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Germaneto, Italy
- 3Magna Græcia University of Catanzaro, Germaneto, Italy
- 4Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA
One of the main indications for stereotactic surgery in Parkinson’s disease (PD) is the control of levodopa-induced dyskinesia. This can be achieved by pallidotomy and globus pallidus internus (GPi) deep brain stimulation (DBS) or by subthalamotomy and subthalamic nucleus (STN) DBS, which usually allow for a cut down in the dosage of levodopa. DBS has assumed a pivotal role in stereotactic surgical treatment of PD and, in fact, ablative procedures are currently considered surrogates, particularly when bilateral procedures are required, as DBS does not produce a brain lesion and the stimulator can be programed to induce better therapeutic effects while minimizing adverse effects. Interventions in either the STN and the GPi seem to be similar in controlling most of the other motor aspects of PD, nonetheless, GPi surgery seems to induce a more particular and direct effect on dyskinesia, while the anti-dyskinetic effect of STN interventions is mostly dependent on a reduction of dopaminergic drug dosages. Hence, the si ne qua non-condition for a reduction of dyskinesia when STN interventions are intended is their ability to allow for a reduction of levodopa dosage. Pallidal surgery is indicated when dyskinesia is a dose-limiting factor for maintaining or introducing higher adequate levels of dopaminergic therapy. Also medications used for the treatment of PD may be useful for the improvement of several non-motor aspects of the disease, including sleep, psychiatric, and cognitive domains, therefore, dose reduction of medication withdrawal are not always a fruitful objective.
Keywords: Parkinson’s disease, dyskinesia, deep brain stimulation, DBS, pallidotomy
Citation: Munhoz RP, Cerasa A and Okun MS (2014) Surgical treatment of dyskinesia in Parkinson’s disease. Front. Neurol. 5:65. doi: 10.3389/fneur.2014.00065
Received: 19 December 2013; Accepted: 16 April 2014;
Published online: 29 April 2014.
Edited by:Alfonso Fasano, Catholic University – A. Gemelli Hospital, Italy
Reviewed by:Francesca Morgante, University of Messina, Italy
Maria Stamelou, University of Athens, Greece
Copyright: © 2014 Munhoz, Cerasa and Okun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Renato P. Munhoz, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, McLaughlin Pavilion 7th Floor Room 7-417, 399 Bathurst Street, Toronto, M5T 2S8 ON, Canada e-mail: firstname.lastname@example.org