[Stereotactic thalamotomy for Parkinsonian and others types of tremor. Experiences of thalamic multiunit burst activity by means of semimicroelectrode].
BACKGROUND
Better understanding of the basic mechanism of disorders of movement, together with improvements in surgery and electrophysiological techniques have led to a resurge of interest in the surgical treatment of patients with tremor. Ventrolateral thalamotomy has been considered to be an alternative neurosurgical treatment for disabled persons including those with drug-resistant Parkinson s disease and other types of tremor.


METHODS
Thirty four of 47 patients had Parkinson s disease (n= 23), essential tremor (n= 4), multiple sclerosis (n= 5), olivopontocerebellar lesion (n= 1) and posttraumatic tremor (n= 1) and did not show satisfactory improvement after drug treatment. The lesions were made in the thalamic nucleus. In 26 patients simultaneous recordings were made of nerve activity in the thalamus and of burst activity.


RESULTS
In 23% of the cases the appropriate site for the final lesion could not be determined in accordance with electrostimulation of the empirical objective. In these patients the objective was determined after observation of the electrophysiological activity localized to the burst activity seen during the operation. The patients were followed-up for 6-24 months (average 12 months); 88% of them had no tremor or moderate contralateral tremor. The patients were assessed on a modified Fahn scale. Average scoring fell from a preoperative evaluation of 73.8 points to 34.0 after three months; 30.7 after six months, 32.0 after 9 months, 37.1 after 12 months and 35.2 points after 18 months.


CONCLUSIONS
Of 47 thalamotomies done, 13 (29%) were successful and 5 (10%) maintained their original state, but no cases became worse or had serious complications.
Balás
I
I
Department of Neurosurgery; Medical School Universit of Pécs, Diagnostic Cente, Pécs, 7624, Hungría. ibalas@apacs.pote.hu
Llumiguano
C
C
Horváth
Z
Z
Kövér
F
F
Dóczi
T
T
D003342:Corpus Striatum / Q000473:pathology / Q000601:surgery; D004558:Electric Stimulation / Q000379:methods; D004564:Electrocoagulation / Q000379:methods; D004566:Electrodes; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010300:Parkinson Disease / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D011300:Preoperative Care; D013238:Stereotaxic Techniques / Q000295:instrumentation; D014202:Tremor / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D020651:Ventral Thalamic Nuclei / Q000473:pathology / Q000601:surgery*