Therapeutic efficacy of unilateral subthalamotomy in Parkinson's disease: results in 89 patients followed for up to 36 months
L. Álvarez (1), R. Macías (1), N. Pavón (1), G. López (1), M.C. Rodríguez-Oroz (2,3), R. Rodríguez (1), M. Álvarez (1), I. Pedroso (1), J. Teijeiro (1), R. Fernández (1), E. Casabona (1), S. Salazar (1), C. Maragoto (1), M. Carballo (1), I. García (1), J. Guridi (2,3), J.L. Juncos (4), M.R. DeLong (4), J. A. Obeso (2,3)
Stereotactic thermocoagulative lesions of the subthalamic nucleus (STN) have been shown to induce significant motor improvement in patients with Parkinson's disease (PD).
PATIENTS AND METHODS
89 patients with PD were treated with unilateral subthalamotomy. 68 patients were available for evaluations after 12 months, 36 at 24 months and 25 at 36 months.
The Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved significantly contralaterally to the lesion in the off and on states throughout the follow-up, except for the on state at the last evaluation. Axial features and signs ipsilateral to the lesion progressed steadily throughout the study. Levodopa daily doses were significantly reduced by 45%, 36% and 28% at 12, 24 and 36 months post-surgery. 14 patients (15%) developed postoperative hemichorea-ballism which required pallidotomy in eight. These 14 patients had significantly higher dyskinesia scores (levodopa induced) preoperatively than the entire cohort.
Unilateral subthalamotomy was associated with significant and sustained motor benefit contralateral to the lesion. Further work is needed to ascertain what factors led to severe, persistent chorea-ballism in a subset of patients. Subthalamotomy may be considered an option in circumstances when deep brain stimulation is not viable.
CITATION J Neurol Neurosurg Psychiatry. 2009 Sep;80(9):979-85