Neurosurgery for Movement Disorders

Movement disorders have been treated neuro- surgically since the 1930s. Current diagnoses for neuro- surgical interventions are Parkinson's disease, essential tremor, multiple sclerosis, and some dystonic disorders such as idio- pathic torsions dystonia. By using stereotactic image-guided techniques, targets can be chosen to treat different symptoms: the ventrointermediate nucleus of thalamus for tremor; the internal globus pallidus for dyskinesia, dystonia, rigidity, aki nesia, and tremor; and the subthalamic nucleus for all cardinal symptoms in advanced Parkinson's disease, including drug- induced hyperkinesia (secondary to reduced drugs). The surgi cal approaches can be divided into three main groups: destructive (e.g., lesional surgery), reversible and adjustable (e.g., permanent electro-inhibition/stimulation), and recon- structive (e.g., fetal nerve cell transplantation). Reconstructive procedures, which are not discussed here, are still in the early developmental phase. All the methods have advantages and dis advantages; therefore, it is important that the right target and technique be chosen for each patient.

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