Treatment of advanced Parkinson's disease by subthalamotomy: one-year results.
We studied effects on parkinsonian features at 6 and 12 months in 12 patients who underwent unilateral ablation of subthalamic nucleus (STN). Microelectrode mapping was used, and a lesion was created in the STN using thermal coagulation and confirmed with magnetic resonance imaging. At 6 months postoperatively, improvements were seen in several areas: 1) Unified Parkinson's Disease Rating Scales II and III (UPDRS II and III) scores, 30% in off period, 38% in on period; 2) Schwab and England Scale (S&E) score, 21%; and 3) on dyskinesia, 85%. Contralateral rigidity, bradykinesia, UPDRS II and III scores, and S&E scores remained improved at 12 months. Daily dosage of levodopa requirement was reduced by 42%. Axial motor features, gait, postural stability, off period tremor, and motor fluctuation improved at 6 and 12 months but showed a decline in benefits at 18 months. Complications include 3 cases of hemiballism, of whom 2 patients recovered spontaneously but 1 died from aspiration pneumonia. One patient had asymptomatic hematoma, and 2 suffered transient postural asymmetries. We conclude that unilateral subthalamotomy results in moderate improvement in all aspects of parkinsonian features, allows reduction in the dose of levodopa required, and ameliorates drug-induced complications throughout 12-month assessments.
Su
Philip C
PC
Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, China. philipsu@ha.mc.ntu.edu.tw
Tseng
Ham-Min
HM
Liu
Hon-Man
HM
Yen
Ruoh-Fang
RF
Liou
Horng-Huei
HH
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D020820:Dyskinesias / Q000175:diagnosis / Q000453:epidemiology; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018476:Hypokinesia / Q000175:diagnosis; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D011187:Posture; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013995:Time
D000978:Antiparkinson Agents; D007980:Levodopa