ABSTRACT
Lesion therapy was considered the standard treatment for advanced Parkinson’s disease (PD) complicated by motor Ÿuctuations until the advent of levodopa and then reemerged during the mid-to late 1990s (Duff and Sime 1997, Tasker et al. 1997a,b, Kumar et al. 1999, Tan 1999, Tsubokawa and Katatama 1999, Olanow 2000, 2002, Kiss et al. 2003, Okun and Vitek 2004, Katayama et al. 2005, Jimenez et al. 2006). Despite the success of brain lesion therapy and its widespread acceptance, eventually it fell out of favor as a preferred surgical treatment. In addition to safety concerns, the reasons for the fall of lesion therapy may have been grounded at least partially in a global “lack of adjustability and reversibility” of the lesion procedure. Safety concerns are even more critical when bilateral procedures are required because of the potential for speech, swallowing, and cognitive decits (Olanow 2002, Hooper et al. 2008). The “rise and fall” history of lesion surgery is thus multifaceted with variable and important historical factors as well as medical factors. We will, in this chapter, attempt to highlight both the historical and recent literature regarding lesion therapy for PD.
