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This post goes along with my "JHMI PD #1" post. Source: Page 6 of the December 1995 issue of "Health After 50", by the John Hopkins Medical Institute of Baltimore, MD. Parkinson's Disease: When to Consider Surgery Three Surgical Options Surgery can be a reasonable choice--but only if you have the specific symptoms for which a procedure was developed, and only when medication produces intolerable side effects or can no longer provide adequate control of symptoms. The three alternatives are: Thalamotomy. In this technique, the surgeon destroys a specific group of cells in the thalamus, the main relay center of the brain. Thalamotomy is appropriate for the 5 to 10% of patients who have a disabling tremor of the hand or arm, and few other symptoms. Improvement is immediate, with 80 to 90% of patients experiencing a significant reduction or even elimination of tremor. The procedure is performed with the patient conscious, under local anesthesia and sometimes sedation. The hospital stay is usually two days, with full recuperation in six weeks. Risks include temporary balance disturbances and numbness around the mouth and in the hand. Brain mapping limits the risk of serious permanent complications (such as paralysis, loss of sensation, and stroke) to less than 1%. Pallidotomy. Using this technique, the surgeon destroys a specific group of cells within the globus pallidus, a portion of the brain's movement center. Although the criteria for pallidotomy have not been firmly established, the technique seems to be most effective for slow movement, tremor, imbalance, and especially the side effects of medication (severe dyskinesia and widely fluctuating symptoms). Like thalamotomy, pallidotomy is performed with the patient conscious, and requires a similar recuperation period. Risks and benefits are also similar, with the additional possibility of damaging peripheral vision. Careful brain mapping limits the risk of visual impairment to between 2 and 5%. Fetal tissue implantation. The goal of this experimental technique is to restore brain function by replacing damaged tissue in the dopamine-producing area of the brain with fetal brain tissue that will produce dopamine. Because of the ethical concerns surrounding use of fetal tissue, it's likely that genetically engineered cells may one day be used instead. Specific criteria and optimal techniques have yet to be determined, and most patients undergo the procedure as part of a study. Short-term research indicates that implantation can cut the need for medication in half, but it may take up to six months for improvement to become apparent. Long-term studies have not yet been completed. The risk of stroke and other serious complications is estimated at no more than 5%. A history of cardiovascular disease, stroke, or dementia precludes surgery.