-The present study, the largest in the literature, was performed to assess the effectiveness and safety of unilateral subthalamic nucleus (STN) lesioning for Parkinson's disease (PD). From August 1999 to September 2000, 21 consecutive patients evaluated pre-and postoperatively by a single examiner were operated. Levodopa intake and dyskinesia, Hoehn & Yahr, Schwab & England and UPDRS motor scores were recorded. Stereotactic CT and MRI and the effects of macrostimulation were used to determine STN coordinates. A single radiofrequency lesion was made (60-75ºC/60"). Concomitant ipsilateral Vim/VOp lesions were made in 8 patients. Using a new technique, we were able to determine the territory of STN involved by the surgical lesion. The Wilcoxon and Mann-Whitney statistical tests were applied to evaluate the surgical results. All recorded parameters showed stable improvement after a mean follow up of 13.5 months. Recurrence occurred in two patients. Contralateral tremor arrest and decrease of rigidity and bradykinesia should be regarded as STN hallmarks to stimulation. Hyperintense lesions in the early-phase MRI seem to be a poor prognostic factor. Lateral territory lesioning correlates with better results. There was no significant difference between the cohorts with and without a Vim/VOp lesion. Dyskinesias happened in two patients (promptly abolished by a Vim/VOp lesion). Other complications were transient and/or rare. In conclusion, STN lesioning is a safe and very effective procedure to treat PD and probably an underutilized operation for those who can not afford the costs of DBS.KEY WORDS: subthalamic nucleus lesioning, deep brain stimulation, stereotactic surgery, subthalamic nucleotomy, subthalamotomy, Parkinson's disease. Lesão unilateral do núcleo subtalâmico: um tratamento seguro e eficaz para a doença de ParkinsonRESUMO -O presente estudo, o maior da literatura, foi realizado para avaliar a eficácia e segurança da lesão unilateral do NST (núcleo subtalâmico) para o tratamento da DP (doença de Parkinson). Entre agosto de 1999 e setembro de 2000, 21 pacientes consecutivos avaliados pré e pós-operatoriamente por um único examinador foram operados. Os seguintes parâmetros foram avaliados: dose diária de levodopa, discinesia induzida pela levodopa, estadiamento da doença, atividades de vida diária e escores motores da UPDRS. RNM e TC estereotáxicas e os efeitos da estimulação com macroeletrodo foram utilizados na determinação das coordenadas do NST. Uma única lesão por radiofrequência foi realizada (60 -75ºC / 60"). Lesão concomitante de Vim/VOp ipsilateral foi realizada em 8 pacientes. Utilizando-se uma nova técnica, foi possível estabelecer o território do NST lesado cirurgicamente. Os testes estatísticos de Wilcoxon e Mann-Whitney foram aplicados para avaliar os resultados cirúrgicos. Todos os parâmetros avaliados apresentaram melhora sustentada após seguimento médio de 13.5 meses. Recidiva ocorreu em 2 casos. Abolição do tremor e redução da rigidez e bradicinesia contralaterais devem ser considerad...

No abstract

Paresthesia-producing (PP), but not periventricular grey (PVG) deep brain stimulation (DBS) proved effective in steady neuropathic pain in 25 patients receiving both, regardless of the PP site stimulated, but PVG-DBS suppressed allodynia or hyperpathia in 3 cases of stroke-induced pain. In patients with stroke-induced central pain, PP-DBS was unpleasant in 6 of 17 (35%), all with allodynia and/or hyperpathia, but not in patients with spinal cord central or peripheral neuropathic pain with allodynia or hyperpathia. Of 11 patients in whom prior ineffective dorsal column stimulation (DCS) produced appropriate paresthesia, none responded to PP-DBS; 5 of 7 did so in whom DCS produced no paresthesia or relieved pain. Periaqueductal grey DBS was nearly always unpleasant, PVG-DBS sometimes was.