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We found that Parkinson's disease(PD) patients receiving autotransplants of the cervical sympathetic ganglia show a significant improvement in the parkinsonian symptoms with a consequent reduction in the daily intake of levodopa. The grafting procedure have recently been modified to further enhance the efficacy of the transplantation. Thus, in order to increase the amount of donor tissue we opted for the endoscopically excised thoracic sympathetic ganglia as a donor. With the aid of CT-guided stereotaxic surgery, we unilaterally placed one transplant deposit in the caudate head and three deposits in the putamen. Four patients that had received the grafts were followed with antiparkinsonian medication being unchanged at least one year postgrafting. Although no patients exhibited a substantial improvement in motor performance rated in either "on" or "off" phase, the awake time spent in "off" phase was reduced by 30-40% in all the patients. In two patients, dyskinesia in "on" phase was also attenuated. Our new transplantation paradigm is encouraging and deserves further investigation.

Pallidotomy has recently regained acceptance as an effective treatment for Parkinson's disease. From our 50 cases of unilateral pallidotomy and 10 cases of staged bilateral pallidotomy, details and indications of the procedure is described. The unilateral pallidotomy is quite effective for L-dopa induced dyskinesia, which usually completely disappears soon after the operation. The effect is long-lasting. When on-off phenomenon exists, unilateral pallidotomy improves off-stage rigidity or akinesia. Symptoms during on-stage are not changed. Indications of pallidotomy is that(1) L-dopa induced dyskinesia, and(2) on-off phenomenon. Bilateral pallidotomy, even by staged one, causes severe drooling, or speech disturbance(the volume of the voice decreases and the articulation worsens), and is not recommended. Vim thalamotomy is, on the other hand, the established treatment for tremor of Parkinson's disease or of essential tremor. The effect is long-lasting. Rigidity or akinesia is not expected to be improved so much.

The effects of current neurosurgical interventions for levodopa-induced dyskiensias (DID) in Parkinson's disease are reviewed. Thalamotomy has been reported to be effective for DID when the lesions include Vo or CM-Pf nucleus, while thalamic deep brain stimulation(DBS) is less effective than thalamotomy. Both pallidotomy and pallidal DBS are probably the most effective neurosurgical treatment for DID, because they significantly improve all of the DID, including off-period dystonia, without reduction of levodopa dosage. Subthalamic DBS has no direct therapeutic effects on DID, but substantially can improve DID as a result of decreased levodopa dosage. The effects of cerebral transplantation on DID remain undefined. More researches are expected to clarify the pathophysiology of DID.