Bilateral subthalamotomy for advanced Parkinson disease
Journal
Surgical Neurology
Journal Volume
68
Journal Issue
5 SUPPL.
Pages
S43-S50
Date Issued
2007
Author(s)
Abstract
Background: Unilateral subthalamotomy has been reported to be effective in the treatment of rigidity, bradykinesia, and tremor of the contralateral limb. However, gait, clinical fluctuation, and postural stability are not significantly improved by unilateral lesioning of the STN in the long term. We sought to determine if bilateral surgery of the STN offers more benefits in the treatment of advanced PD. Methods: Radiofrequency thermal coagulation was performed bilaterally in the STN in 10 patients. Under microelectrode and stereotactic guidance, surgery was directed at the dorsolateral portion of the STN in stages and followed by MRI in each patient to confirm lesion location. Patients have been followed for a median duration of 26 months as measured from the date of first surgery (range, 6-48 months) with UPDRS before and after surgery. Results: Bilateral subthalamotomy demonstrated persistent benefits in bradykinesia, rigidity of the limbs, and consequently the improvement in activities of daily living, motor function, Schwab and England scales. In addition, significant improvement in axial motor features, gait, postural stability, and clinical fluctuation were present with bilateral STN surgeries. The benefits were sustained at the last evaluation period of 36 months. Tremor and drug-induced dyskinesia improved in early postoperative period, but the benefits declined over time. The reduction of daily l-dopa equivalent was 34%. No speech impairment was observed. Mild choreic movement occurred in 2 of 20 procedures that resolved spontaneously in 4 to 8 weeks. Conclusion: For advanced PD present with bilateral symptoms, axial motor impairment, or clinical fluctuation, staged bilateral subthalamotomy appears as a safe and effective treatment in the long term. ? 2007 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
adult; aged; article; bradykinesia; brain depth stimulation; clinical article; clinical feature; controlled study; daily life activity; disease course; disease duration; female; follow up; human; male; microelectrode; motor performance; neuropsychological test; nuclear magnetic resonance imaging; outcome assessment; Parkinson disease; postoperative period; radiofrequency ablation; rigidity; stereotaxic surgery; subthalamic nucleus; surgical technique; thalamotomy; Aged; Catheter Ablation; Dyskinesia, Drug-Induced; Female; Follow-Up Studies; Functional Laterality; Humans; Hypokinesia; Levodopa; Male; Microelectrodes; Middle Aged; Muscle Rigidity; Neural Pathways; Parkinson Disease; Radiosurgery; Subthalamic Nucleus; Time; Treatment Outcome; Tremor
Type
journal article