Treatment of advanced Parkinson's disease by subthalamotomy: One-year results
Journal
Movement Disorders
Journal Volume
18
Journal Issue
5
Pages
531-538
Date Issued
2003
Author(s)
Abstract
We studied effects on parkinsonian features at 6 and 12 months in 12 patients who underwent unilateral ablation of subthalamic nucleus (STN). Microelectrode mapping was used, and a lesion was created in the STN using thermal coagulation and confirmed with magnetic resonance imaging. At 6 months postoperatively, improvements were seen in several areas: 1) Unified Parkinson's Disease Rating Scales II and III (UPDRS II and III) scores, 30% in off period, 38% in on period; 2) Schwab and England Scale (S&E) score, 21%; and 3) on dyskinesia, 85%. Contralateral rigidity, bradykinesia, UPDRS II and III scores, and S&E scores remained improved at 12 months. Daily dosage of levodopa requirement was reduced by 42%. Axial motor features, gait, postural stability, off period tremor, and motor fluctuation improved at 6 and 12 months but showed a decline in benefits at 18 months. Complications include 3 cases of hemiballism, of whom 2 patients recovered spontaneously but 1 died from aspiration pneumonia. One patient had asymptomatic hematoma, and 2 suffered transient postural asymmetries. We conclude that unilateral subthalamotomy results in moderate improvement in all aspects of parkinsonian features, allows reduction in the dose of levodopa required, and ameliorates drug-induced complications throughout 12-month assessments. ? 2003 Movement Disorder Society.
SDGs
Other Subjects
bromocriptine; levodopa; pergolide; adult; article; aspiration pneumonia; body posture; bradykinesia; brain mapping; brain surgery; clinical article; clinical feature; clinical trial; controlled clinical trial; controlled study; dyskinesia; female; gait; gait disorder; hematoma; hemiballism; human; male; mortality; motor performance; muscle rigidity; neurologic examination; nuclear magnetic resonance imaging; Parkinson disease; postoperative period; priority journal; rating scale; scoring system; side effect; subthalamic nucleus; subthalamotomy; surgical technique; symptomatology; thermocoagulation; treatment outcome; tremor; Adult; Aged; Antiparkinson Agents; Dyskinesias; Electrocoagulation; Female; Follow-Up Studies; Humans; Hypokinesia; Levodopa; Magnetic Resonance Imaging; Male; Microelectrodes; Middle Aged; Parkinson Disease; Postoperative Complications; Posture; Questionnaires; Severity of Illness Index; Subthalamic Nucleus; Time
Type
journal article