ABSTRACT
Parkinson’s disease (PD) is a progressive neurodegenerative disease that is esti-
mated to affect between 100 and 200 per 100,000 people over 40 years of age, and
over one million people in North America alone (1,2). Although first described by
James Parkinson in 1817 in his “Essay on the Shaking Palsy,” (3) an effective
medical treatment was not discovered until 1967, when levodopa was introduced.
Prior to that, the main treatments for PD were surgical. The number of surgeries
on PD patients peated after Spiegel and Wycis introduced stereotaxis in 1947 (4),
allowing for more precise localization of surgical lesions in the basal ganglia. But
with the widespread use of levodopa, surgery for PD almost disappeared. Despite
the effectiveness of levodopa on motor symptoms in PD, long-term use of this
drug was associated with disabling side effects, such as dyskinesias and
wearing-off, which were difficult to manage medically. Interest in surgical pro-
cedures for PD resumed with the success of pallidotomy in the early 1990s (5)
and continued when Benabid and his colleagues published their findings on
high frequency deep brain stimulation (DBS) for the treatment of motor symp-
toms in PD (6). DBS of the subthalamic nucleus (STN) is now an FDA-approved
treatment for medically refractory PD.
