Lesional surgeries for movement disorders

An expert specialist will first carefully identify the area in the brain that is causing the problem.

This will involve taking a thorough history of the symptoms, a full clinical examination, and use of imaging such as MRI and CT scans.

Modern lesional surgeries use a variety of different techniques.

Stereotactic methods use tiny probes to find the correct location in the brain for creating the lesion. The lesion is then made by delivering an electrical current or high dose of localised radiation (gamma knife).

MRI-guided focused ultrasound therapy can also be used and is minimally invasive. The surgery is normally performed while the patient is awake to identify the correct site for the lesion.

Our expert surgeons and anaesthetists will be on hand to ensure comfort and safety at all times.

There are two main sites that are targeted with lesional surgeries, depending on the symptoms. The first is called the thalamus (a thalamotomy procedure), which is considered the best site to reduce tremor.

The second is the ‘globus pallidus’ (a pallidotomy procedure), which is often associated with the other symptoms of Parkinson’s disease and dyskinesias.

Uncomplicated lesional surgery generally requires a hospital stay for 2-3 days, but this may be longer if there are unexpected problems following the surgery.

There is evidence of good results for lesional surgeries in many of the conditions causing tremor. They are particularly effective in treating medication-resistant Parkinson’s disease.

A study in patients suffering from multiple sclerosis also showed a 60% reduction in tremor severity at three months.

As this surgical method requires a single lesion to be identified, its use is limited. It can’t be used to treat conditions where multiple areas of the brain are affected, such as a tremor with sensory loss or a tremor affecting both hands.

However, with the development of new surgical techniques this may become more likely in the future.

Tremor is an example of a condition that can be treated using lesional surgery.

It is an uncontrollable shaking or trembling that most commonly occurs in the hands, but can also affect the arms, legs and face.

It can occur as a single symptom, such as in essential tremor, or as a result of other conditions such as multiple sclerosis, or following an injury.

Parkinson’s disease is most often known to cause a tremor of the hands. But it can cause many other symptoms, including freezing (feeling like feet are glued to the ground), rigidness and slowing of movements.

Lesional surgery can also be used to treat these symptoms as well as the involuntary movements (dyskinesias) that can occur as a side effect of the medications taken for Parkinson’s disease.

The benefit of having stereotactic surgery is that there is a relatively small incision; this means faster wound healing and a smaller scar.

With every surgery there are still general risks associated, including:

• Excessive bleeding – especially if there is a pre-existing bleeding problem or use of blood thinning medications
• Infections at the site of incision
• Development of blood clots in the legs (deep vein thrombosis) or in the lung (pulmonary embolism).

While the lesion made in the brain is often very small, its closeness to other brain areas mean there is a small risk of:

• Temporary confusion
• Temporary balance problems
• Speech changes
• Weakness, loss of sensation and, rarely, paralysis
• Stroke caused by bleeding in the brain.

The use of our state-of-the-art imaging methods means these risks are minimised as much as possible. Our team will ensure all the correct precautions are in place to manage these risks before and after the surgery.

Lesional surgery is often compared to Deep Brain Stimulation (DBS). This is another innovative treatment for movement disorders offered by The London Clinic. DBS uses reversible electrode implants in the brain.

Unlike DBS, lesional surgery is permanent and can’t be reversed. On the other hand, this means it doesn’t require as many visits to the hospital, as the DBS device requires regular programming.