# Parkinson's Disease — GCMD Library living collection

Everything in the library about Parkinson's disease — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 45 cited statements

## Episodes
### Fundamentals
- [The Surgical Window: Why Timing Matters as Much as Skill | Functional Surgery Minute #05](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627) — video · 2:03 · [machine version](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627.md)

### Case-Based Learning
- [Movement Disorder Exam Questions for Neurosurgeons | MCQs, Concepts and Key Topics](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623) — video · 9:40 · [machine version](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623.md)

### In-Depth Reviews
- [3 Eras of Parkinson's Surgery: Destroy → Modulate → Respond](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628) — video · 2:08 · [machine version](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=0) Introduction to Functional Neurosurgery in Examinations (Ep 1)
- [1:24](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=84) Symptom Response to Deep Brain Stimulation (Ep 1)
- [2:23](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=143) Target Selection for Deep Brain Stimulation (Ep 1)
- [4:12](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=252) Patient Selection Criteria (Ep 1)
- [6:15](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=375) Stimulation Side Effects and Anatomical Correlates (Ep 1)
- [8:49](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=529) Summary and Series Preview (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=0) Introduction: The Surgical Window Concept (Ep 2)
- [0:28](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=28) Lumbar Disc Prolapse: Windows That Close (Ep 2)
- [1:02](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=62) Parkinson's Disease: The DBS Window (Ep 2)
- [1:31](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=91) Clinical Judgment and Timing Decisions (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=0) Era 1: The Ablation Era - Permanent Lesions for Parkinson's (Ep 3)
- [0:44](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=44) Era 2: The DBS Era - Reversible Stimulation Replaces Destruction (Ep 3)
- [1:21](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=81) Era 3: The Adaptive Era - Closed-Loop Responsive Stimulation (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Functional neurosurgery is under-taught in basic training and most units don't do much of it. (opinion) [Ep 1 · 0:29](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=29)
- Examiner expectations for functional neurosurgery are low and basic knowledge is sufficient. (opinion) [Ep 1 · 0:36](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=36)
- Functional neurosurgery splits into three exam topics: movement disorders, pain surgery, and epilepsy. (clinical) [Ep 1 · 0:49](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=49)
- Bradykinesia is mandatory for the diagnosis of Parkinson's disease. (clinical) [Ep 1 · 1:31](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=91)
- Tremor responds best to deep brain stimulation in Parkinson's disease. (clinical) [Ep 1 · 1:35](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=95)
- Gait freezing, speech, and cognition respond poorly to deep brain stimulation. (clinical) [Ep 1 · 1:44](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=104)
- Cognition can be worsened by deep brain stimulation. (clinical) [Ep 1 · 1:48](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=108)
- Balance, speech, and postural instability all respond poorly to deep brain stimulation. (clinical) [Ep 1 · 2:11](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=131)
- The subthalamic nucleus is the first choice target for deep brain stimulation in Parkinson's disease. (guideline) [Ep 1 · 2:25](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=145)
- The globus pallidus internus is the second choice target for deep brain stimulation in Parkinson's disease. (guideline) [Ep 1 · 2:29](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=149)
- When dyskinesia dominates in Parkinson's disease, the globus pallidus internus is the preferred target because it smooths dyskinesia directly. (clinical) [Ep 1 · 2:40](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=160)
- When tremor dominates in Parkinson's disease, the ventral intermediate nucleus of the thalamus is the preferred target. (clinical) [Ep 1 · 2:48](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=168)
- The anterior limb of the internal capsule is an obsessive compulsive disorder target, not a Parkinson's disease target. (clinical) [Ep 1 · 3:19](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=199)
- Inclusion criteria for deep brain stimulation include disease over 5 years, a meaningful levodopa response, disabling fluctuations, or refractory tremor. (guideline) [Ep 1 · 4:12](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=252)
- Exclusion criteria for deep brain stimulation include dementia, untreated depression or psychosis, and atypical Parkinsonism like progressive supranuclear palsy and multiple system atrophy. (guideline) [Ep 1 · 4:29](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=269)
- The levodopa challenge predicts the response to deep brain stimulation, not severity of disease. (clinical) [Ep 1 · 4:51](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=291)
- Stimulation of the subthalamic nucleus roughly reproduces the patient's best medication on state. (clinical) [Ep 1 · 4:59](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=299)
- A good levodopa response predicts a good stimulation response to deep brain stimulation. (clinical) [Ep 1 · 4:59](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=299)
- Atypical Parkinsonism does not respond to deep brain stimulation and is a contraindication. (clinical) [Ep 1 · 5:48](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=348)
- At the subthalamic nucleus, medial spread of stimulation hits the third cranial nerve and red nucleus, causing diplopia. (clinical) [Ep 1 · 6:22](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=382)
- At the subthalamic nucleus, lateral spread of stimulation hits the internal capsule, causing contralateral twitching and dysarthria. (clinical) [Ep 1 · 6:32](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=392)
- At the globus pallidus internus, ventral spread of stimulation hits the optic tract, causing phosphenes (flashes of light). (clinical) [Ep 1 · 6:39](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=399)
- At the globus pallidus internus, posteromedial spread of stimulation hits the internal capsule, causing muscle contraction. (clinical) [Ep 1 · 6:48](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=408)
- The side effect during stimulation tells you where the electrode is, and you correct by moving away from the structure you're hitting. (clinical) [Ep 1 · 6:53](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=413)
- Motor fibers run in the internal capsule just lateral to the subthalamic nucleus. (clinical) [Ep 1 · 7:09](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=429)
- Twitching during subthalamic nucleus stimulation means the electrode is too lateral and should be moved medially. (clinical) [Ep 1 · 7:18](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=438)
- Reducing voltage during stimulation just shrinks the therapeutic window and doesn't fix electrode position. (clinical) [Ep 1 · 7:37](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=457)
- Diplopia during subthalamic nucleus stimulation is the medial side effect from spread toward the third cranial nerve and red nucleus. (clinical) [Ep 1 · 7:50](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=470)
- The optic tract is ventral to the globus pallidus internus, so ventral spread produces phosphenes. (clinical) [Ep 1 · 8:10](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=490)
- The dopamine transporter scan separates Parkinson's disease from essential tremor and drug-induced tremor by showing reduced uptake in the posterior putamen. (clinical) [Ep 1 · 8:24](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=504)
- The dopamine transporter scan does not distinguish Parkinson's disease from atypical Parkinsonism. (clinical) [Ep 1 · 8:39](https://qa.library.globalcastmd.com/watch/movement-disorder-exam-questions-for-neurosurgeons-mcqs-concepts-and-key-topics-13623?t=519)
- In neurosurgery, the brain and spine do not forgive damage. (clinical) [Ep 2 · 0:08](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=8)
- Timing is the most important factor in neurosurgical outcomes. (opinion) [Ep 2 · 0:14](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=14)
- Operating too early represents unnecessary risk. (clinical) [Ep 2 · 0:23](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=23)
- Operating too late represents a lost opportunity. (clinical) [Ep 2 · 0:26](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=26)
- Most lumbar disc prolapse cases resolve with rest and medication without requiring surgery. (clinical) [Ep 2 · 0:28](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=28)
- Surgery for lumbar disc prolapse is indicated when medication fails. (clinical) [Ep 2 · 0:36](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=36)
- When lumbar disc patients present late with established foot weakness or bladder control loss, surgery can stop further damage but cannot restore what is already lost. (clinical) [Ep 2 · 0:42](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=42)
- In Parkinson's disease, medication works well initially, then tremor becomes uncontrolled. (clinical) [Ep 2 · 1:02](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=62)
- The optimal window for deep brain stimulation in Parkinson's is when medication wearing-off becomes disabling and daily life breaks down. (clinical) [Ep 2 · 1:09](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=69)
- Deep brain stimulation performed at the optimal window changes lives in Parkinson's disease. (clinical) [Ep 2 · 1:14](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=74)
- If deep brain stimulation is delayed until the patient no longer responds to dopamine or cognition declines, the same operation that could have helped will cause harm. (clinical) [Ep 2 · 1:20](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=80)
- Brain and spine damage is often permanent. (clinical) [Ep 2 · 1:31](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=91)
- Neurosurgery requires more than technical skill; it requires good judgment and honest decisions about timing. (opinion) [Ep 2 · 1:36](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=96)
- Good neurosurgical judgment includes recognizing when the surgical window has passed, has not yet arrived, or when surgery is not indicated. (clinical) [Ep 2 · 1:45](https://qa.library.globalcastmd.com/watch/the-surgical-window-why-timing-matters-as-much-as-skill-functional-surgery-minut-13627?t=105)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Parkinson's surgery has evolved through 3 revolutions over 70 years — The host summarizing a resource [Ep 3 · 0:00](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=0)
- In the ablation era, thalamotomy in the VIM silenced tremor — The host summarizing a resource [Ep 3 · 0:23](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=23)
- Pallidotomy in the GPi eased rigidity, slowness, and dyskinesias — The host summarizing a resource [Ep 3 · 0:27](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=27)
- Ablative lesions were permanent and could not be undone or adjusted as disease progressed — The host summarizing a resource [Ep 3 · 0:33](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=33)
- In 1987 in Grenoble, Benabid switched on high frequency stimulation above 100 hertz and tremor vanished instantly and reversibly — The host summarizing a resource [Ep 3 · 0:48](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=48)
- Stimulating the STN produced the same benefit as destroying it, demonstrating the benefit was never about the tissue — The host summarizing a resource [Ep 3 · 1:01](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=61)
- DBS allows surgeons to adjust amplitude, frequency, and pulse width and treat both sides safely — The host summarizing a resource [Ep 3 · 1:08](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=68)
- The early STEM trial confirmed DBS beat medical therapy on quality of life — The host summarizing a resource [Ep 3 · 1:17](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=77)
- Adaptive DBS devices record local field potentials from the STN — The host summarizing a resource [Ep 3 · 1:27](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=87)
- Pathological beta oscillations at 13 to 30 Hz suppress movement in Parkinson's disease — The host summarizing a resource [Ep 3 · 1:36](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=96)
- Adaptive DBS fires stimulation when beta oscillations appear and eases off when they fade — The host summarizing a resource [Ep 3 · 1:40](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=100)
- Adaptive DBS results in less unnecessary current, longer battery life, and fewer side effects — The host summarizing a resource [Ep 3 · 1:45](https://qa.library.globalcastmd.com/watch/3-eras-of-parkinson-s-surgery-destroy-modulate-respond-13628?t=105)

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