Effective surgical treatment for Parkinson's disease

The study evaluated the effects of bilateral deep brain stimulation for relief of advanced Parkinson's disease.

The study was carried out by a team from the Elsternwick Private Hospital - Professor and Director of the Movement Disorders Program, Robert Iansek, Research Physiotherapist Ms Frances Huxham, and The Alfred Hospital's Director of Neurosurgery, Professor Jeffrey Rosenfeld.

In the study, 14 patients diagnosed with severe, poorly-controlled motor fluctuations were selected for surgical treatment. Following treatment, motor performance was improved for at least six months, when patients were assessed both with and without their levodopa medication.

The surgical treatment involves implanting electrodes into the sub thalamic area of the brain: the electrodes are linked to a programmable stimulation device implanted in the chest wall similar to a pacemaker.

Professor Iansek said: "The ability to adjust the electrical input enables flexible symptom management as the disease progresses."

Despite some serious complications, and a high rate of minor complications in the study, complications due to stimulation alone were minor and reversible.

Professor Iansek described the results as promising, while suggesting the need to improve accuracy and reduce side-effects if this approach is to become an acceptable and more widely used form of management of end-stage Parkinson's disease.

In an editorial in the same issue of the MJA, Dr Victor Fung and Professor John Morris of the Department of Neurology, Westmead Hospital, and Dr Malcolm Pell of the Department of Neurosurgery, St Vincent's Hospital, Sydney stressed that while motor disability can be improved through levodopa treatment, the effectiveness of each dose is shortened after three to five years, and many patients begin to experience fluctuations in their motor function. Involuntary movements also appear, in particular painful posturing of the legs or arms, as the beneficial effect of levodopa wears off.

Dr Fung and his colleagues said: "It is in patients with severe, poorly controlled motor fluctuations that surgical treatment has re-emerged as a treatment option. While the procedure is not without risk, overall, it is an exciting and encouraging development."

The Medical Journal of Australia is a publication of the Australian Medical Association.

---

CONTACTS: (Research) Professor Robert Iansek

Elsternwick Private Hospital, Vic

(03) 9570 1020 (B/H)

(03) 9387 1000 Pager (A/H)

(Editorial) Dr Victor Fung

Westmead Hospital, NSW

(02) 9845 6793 (B/H)

(0413) 991505 (A/H)

Sarah Crichton

AMA

(0419) 440 076