Functional Neurosurgery for Involuntary Movement Disorders

Abstract

Ablative procedures and deep brain stimulation currently constitute a major part of functional neurosurgery for involuntary movement disorders. The target brain structures for lesion-making surgery and deep brain stimulation are comprise of the motor thalamus, the globus pallidus, and the subthalamic nucleus. With the option of either of the 2 surgical modalities that can be performed in these brain nuclei, surgical treatments for movement disorders should be tailored according to individual patients'conditions. In this review, we first summarize a proposed model of a functional neural circuit involving the basal ganglia and the motor thalamus, which provides a better understanding of the pathophysiology of movement disorders as well as a scientific rationale for determining proper stereotactic targets. We then review the present status of surgical treatments in Parkinson's disease with a special reference to thalamotomy and pallidal stimulation.