Abstract
Surgery has become a treatment option for certain movement disorders such as Parkinson's disease, essential tremor, and dystonia. Surgical intervention is indicated when patients are refractory to medical treatment or experience significant complications from medication use. Surgical treatment approaches have transformed the management of Parkinson's disease and other movement disorders such as essential tremor and dystonia. Treatment options for motor symptoms in these disorders include: deep brain stimulation electrode implantation, lesioning surgery (pallidotomy, thalamotomy, subthalamotomy), and continuous dopamine agonist infusion devices. These therapies act through one of two mechanisms: improving motor symptoms via stimulation or targeted lesioning of the motor circuit, or providing continuous delivery of dopamine agonist medication. The decision regarding which method to select is made by a multidisciplinary team comprising neurologists, neurosurgeons, and neuropsychologists/neuropsychiatrists, based on factors such as the patient's clinical status, treatment efficacy, ease of use, and risks of the treatment method, with the goal of improving disease symptoms and quality of life. Deep brain stimulation (DBS) therapy involves modulating neural networks through electrical current delivered via electrodes implanted in the brain and connected to a neurostimulator. Since the introduction of levodopa for treatment, deep brain stimulation is considered the second major breakthrough in the treatment of Parkinson's disease. In 1987, Benabid and colleagues reported suppression of tremor with high-frequency electrical stimulation of the thalamic region. This surgical approach provided a reversible and adjustable method for tremor control compared with lesioning surgery, and DBS was ultimately approved by the FDA for the treatment of essential tremor and unilateral Parkinsonian tremor. Following this development, based on prior experience with pallidotomy and the marked improvement in Parkinson's disease symptoms observed with subthalamic nucleus lesioning in non-human primates, high-frequency electrical stimulation of the internal globus pallidus and subthalamic nucleus was subsequently performed. Based on the results of clinical trials, the FDA approved the application of DBS for the treatment of Parkinson's disease in 2003. The field of DBS has continued to advance, with progress in understanding of neural mechanisms, technological innovation, and the development of next-generation DBS systems. In Vietnam, Nguyen Tri Phuong Hospital was the first institution approved to perform deep brain stimulation surgery for the treatment of Parkinson's disease, having performed more than 50 cases since 2012, achieving very favorable outcomes (a 39% improvement in UPDRS Part III scores in the off-medication state, and a 50.8% reduction in daily levodopa dosage), thereby improving patients' quality of life.
