Stereotactic subthalamic nucleus lesioning for the treatment of Parkinson's disease.
This study was performed to evaluate the effectiveness and safety of unilateral STN lesioning in 23 patients with PD. L-Dopa intake and dyskinesia, Hoehn & Yahr, Schwab & England, and UPDRS motor scores were recorded pre- and postoperatively. Stereotactic MRI and CT and macrostimulation were used to establish target coordinates. A single RF lesion was performed. All patients underwent postoperative MRI. Contralateral tremor arrest and decrease of rigidity and bradykinesia should be regarded as hallmarks to STN stimulation. All recorded parameters were significantly improved after a mean follow-up of 13.5 months. Patients with STN lateral territory lesioning (alpha <0.05), younger than 61 years and with a duration of the disease between 6 and 9 years (alpha >0.05) did better than the others. The recurrence rate was 10%. Two patients developed dyskinesias which were completely resolved by a Vim/VOp lesion. Other significant complications were rare. The authors conclude that unilateral STN lesioning is a safe and very effective procedure to treat PD.
Vilela Filho
O
O
Stereotactic and Functional Neurosurgery Service and Parkinson's Disease and Movement Disorders Unity, Hospital das Clínicas, Medical School, Universidade Federal de Goiás, Brazil. ovf@ih.com.br
Silva
D J
DJ
Souza
H A
HA
Cavalcante
J E
JE
Sousa
J T
JT
Ferraz
F P
FP
Silva
L G
LG
Santos
L F
LF
D000978:Antiparkinson Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003221:Confusion / Q000209:etiology; D004401:Dysarthria / Q000209:etiology; D020820:Dyskinesias / Q000209:etiology; D004558:Electric Stimulation; D004564:Electrocoagulation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D012449:Safety; D012720:Severity of Illness Index; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa