The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on subthalamotomy for Parkinson's disease.
As part of the NICE's work programme, the current guidance was considered for review but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.
This procedure is used to treat Parkinson's disease.
Parkinson's disease is a chronic disease of the brain characterised by gradually worsening tremor, muscle rigidity and difficulties with starting and stopping movements. The condition is usually treated with drugs. Surgery may be considered in people who have responded poorly to drugs, who have severe side-effects from medication, or who have severe fluctuations in response to drugs (on-off syndrome).
Parkinson's disease is common, affecting about 0.5% of people aged 65 to 74 and 1-2% of people aged 75 and over. Experts believe that 1 to 10% of people with Parkinson's disease might be suitable for brain surgery.
Surgery for Parkinson's disease is carried out on structures within the brain that are responsible for the modification of movements, such as the thalamus, the globus pallidus and the subthalamic nucleus. Each of these structures consists of two parts; one on the left hand side of the brain and one on the right. Surgery may be carried out on one or both sides.
Surgery may involve destruction of parts of these nuclei (thalamotomy, pallidotomy, or subthalamotomy) or the insertion of electrodes into these nuclei so that they can be electrically stimulated (thalamic, pallidal or subthalamic deep brain stimulation). All these procedures carry a risk of stroke, confusion and speech and visual problems.
Surgery involves inserting very fine needles into the brain through small holes made in the skull. The exact points of insertion may be different in each patient. In subthalamotomy, a part of the subthalamic nucleus is destroyed using heat or radiofrequency. The procedure is usually carried out under local anaesthetic. Patients remain awake during the procedure so that effects on movements can be monitored.