Parkinson’s disease is a neural degenerative disorder. It results from a progressive loss of dopamine secreting cells. This affects the nigrostriatal tract.

Parkinson’s Symptoms

Parkinson’s disease has a collection of symptoms including:

  • tremors
  • rigidity
  • reduced or decreased movement
  • impaired gait or ability to walk

Parkinson’s Disease Treatment

Once the diagnosis of Parkinson’s disease is made the initial treatment is medical. This is done under the supervision of a movement disorder neurologist along with supportive medical therapy.

Deep Brain Stimulation For Parkinson’s Disease

Deep brain simulation surgery is a method of treatment for Parkinson’s disease. It provides safe and effective control of the symptoms of Parkinson’s disease. It can also help reduce the medication requirements by up to 50 to 70%. The candidates for such therapy are carefully chosen. Most commonly this includes:

  • patients who have moderate to severe Parkinson’s disease and whose symptoms are progressively worsening or are medically unmanageable
  • patients who have wide motor fluctuations whilst on medical therapy
  • patients with an intolerance or who are developing adverse effects from medical therapy

There are several sites in the brain which are targets for deep brain stimulation in Parkinson’s disease. The main site is the subthalamic nucleus. Other sites may be chosen depending on whether some symptoms are more pronounced and troublesome than the others. These include the thalamus, the posterior subthalamic area or the pedunculopontine nucleus.

DBS therapy provides effective control of symptoms and improved quality of life over a medium to long term. However, it is important to understand that it does not slow the progression of the neurodegenerative disease.


Frameless Deep Brain Stimulation

Deep brain stimulation is a well-established mode of treatment for movement disorders. The most common of which is Parkinson’s Disease. This is a stereotactic surgical procedure which requires accurate targeting and placement of electrodes in various areas of the brain .
frame used for deep brain stimulation
DBS with CRW frame

The CRW Framed Technique

Traditionally, this procedure has been done using a framed technique. This involves placing a frame onto the patient’s skull using screws. The operation is performed with the patient awake, with the frame on their skull and fixed on to the operating table. This can very challenging for the surgeon and is a formidable undertaking for a patient. Unsurprisingly, not many patients opt to have this type of surgery.
Now many centres in the world have moved on to doing this operation while the patient is asleep. Over time there has been advances in imaging technology and electrode improvements. This enhances the surgeon’s ability to clearly visualise the target for stimulation therapy.
frameless deep brain stimulation
Starfix Frameless DBS

The Frameless Technique

Another significant development is the evolution of the “Frameless Deep Brain Stimulation” technique. This technique uses a custom made patient specific frame. This replaces the cumbersome traditional frame which in addition to being on the patients skull, also needs to be attached to the operating table for the duration of the surgery.
This technique along with the ability to do the operation asleep makes patients more accepting of deep brain stimulation surgery. Published current medical literature has shown results are as successful as the traditional technique.
Mr Nair is the only surgeon in Victoria who currently offers this type of frameless stereotactic surgery. To ensure a successful outcome, we use intraoperative CT and MRI scans. These confirm the accurate positioning of electrodes during the operation.

Advantages of Asleep Frameless Deep Brain Stimulation:

  • Avoids patients having to stay awake for the whole duration of the operation
  • Better patient experience and acceptance
  • Does not require patients to skip medications for the surgery
  • Avoids multiple intra-operative recording electrode insertion and possible risk of bleeds
  • Reduced loss of cerebrospinal fluid
  • Enables for a reduced operation and anaesthetic time
  • Ability to confirm accuracy by performing CT/MRI scans within the operating room itself

Research and advances in treatment for Parkinson’s disease

Mr Nair is the neurosurgeon who leads a pioneering team at the Royal Melbourne Hospital. This team have been performing ground breaking research in the treatment of Parkinson’s disease.

Under his leadership the surgical team performed the world’s first ever implantation of stem cells as part of a clinical trial. Together the team are trying to develop alternative and more effective treatment for Parkinson’s disease.

As of now, the stem cell therapy is not a mainstream treatment option for Parkinson’s disease. The current status is that it is in a phase one trial. Previous research studies have been conducted in primates. The results have been extremely promising offering hope to patients and doctors.

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To make an appointment with one of our neurosurgeons, please call 03 9329 4761.

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