Subthalamotomy for advanced Parkinson disease.
OBJECTIVE
The aim of this study was to determine if subthalamotomy is effective in treating advanced Parkinson disease (PD).


METHODS
The authors performed microelectrode mapping-guided stereotactic surgery on the subthalamic nucleus in eight patients with PD. Lesioning was performed using radiofrequency heat coagulation and confirmed with magnetic resonance imaging. Three patients who underwent unilateral and four with bilateral subthalamotomy were evaluated for up to 18 months according to the Unified PD Rating Scale (UPDRS). One patient who underwent unilateral subthalamotomy died 6 months postsurgery. At 3 months into the "off" period after surgery, there were significant improvements in contralateral bradykinesia (p < 0.0002), rigidity (p < 0.0001), tremor (p < 0.01), axial motor features (p < 0.02), gait (p < 0.03), postural stability (p < 0.03), total UPDRS scores (p < 0.03), and Schwab and England scores (p < 0.04). The benefits were sustained at 6, 12, and 18 months, except for the improvement in tremor. At 12 months into the "on" period, significant benefits were present for motor fluctuation (p < 0.04), on dyskinesia (p < 0.006), off duration (p < 0.05), total UPDRS score (p < 0.02), and contralateral tremor (p < 0.05). Benefits for motor fluctuation, off duration, and off-period tremor were lost after the 18-month follow-up period. The levodopa requirement was reduced by 66% for the unilateral and 38% for the bilaterally treated group. Bilateral subthalamotomy offered more benefits than did unilateral surgery for various parkinsonian features in both the on and off periods. Three patients suffered hemiballismus, two recovered spontaneously, and one died of aspiration pneumonia after discontinuation of levodopa.


CONCLUSIONS
These findings indicate that subthalamotomy can ameliorate the cardinal symptoms of PD, reduce the dosage of levodopa, diminish complications of the drug therapy, and improve the quality of life.
Su
Philip C
PC
Department of Neurology, National Taiwan University Hospital, Taipei, ROC. philipsu@ha.mc.ntu.edu.tw
Tseng
Ham-Min
HM
Liu
Hon-Man
HM
Yen
Ruoh-Fang
RF
Liou
Horng-Huei
HH
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D020820:Dyskinesias / Q000601:surgery; D005260:Female; D007839:Functional Laterality; D006801:Humans; D018476:Hypokinesia / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D016634:Radiosurgery; D020531:Subthalamic Nucleus / Q000601:surgery*; D016896:Treatment Outcome; D014202:Tremor / Q000188:drug therapy / Q000473:pathology / Q000601:surgery
D000978:Antiparkinson Agents; D007980:Levodopa