Movement disorders : official journal of the Movement Disorder Society
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There has been a resurgence in the use of neurosurgical procedures for the treatment of Parkinson's disease (PD). Pallidotomy has become a widely performed procedure on the basis of reports which describe marked reduction of levodopa-induced dyskinesias and variable improvement in parkinsonism. Preliminary reports of the effects of globus pallidus internus (GPi) and subthalamic nucleus (STN) deep brain stimulation (DBS) have also been promising. ⋯ GPi DBS may have effects similar to pallidotomy, but might be safer when bilateral procedures are required. Bilateral STN DBS may improve off parkinsonism more than other procedures and might also improve on-period motor function. A randomized trial will be required to determine which procedure is most effective for patients with different clinical features.