Dorsal subthalamotomy for Parkinson's disease

Abstract

We report our experience of unilateral subthalamotomy in patients with Parkinson's disease (PD). Eleven patients were included in a pilot, open‐labeled study to assess the effect of unilateral lesion of the subthalamic nucleus (STN) with a minimum of 12 months of follow‐up. The guidelines of CAPIT (Core Assessment Program for Intracerebral Transplantation) were followed for recruitment into the study and follow‐up assessment. Levodopa equivalents daily intake (mean 967 mg) were unchanged during the first 12 months in all but one patient who stopped medication. The sensorimotor region of the STN was defined by semimicrorecording and stimulation and a thermolytic lesion was placed accordingly. There was a significant reduction in both UPDRS parts II and III in the “off” state at 1‐, 6‐, and 12‐month follow‐up. This effect was maintained in four patients up to 24 months. The dyskinesia score did not change postoperatively. Lesion‐induced dyskinesias were not a management problem except in one patient who developed a large infarction several days postsurgery. This initial study indicates that a lesion of the STN is not generally associated with hemiballismus in PD. Subthalamotomy may induce considerable motor benefit and could become another surgical option under specific circumstances. Mov. Disord. 16:72–78, 2001. © 2001 Movement Disorder Society.

Unilateral subthalamic nucleus lesioning: a safe and effective treatment for Parkinson's disease

“…Additionally, other publications demonstrated the significant improvement presented by parkinsonian patients who suffered from vascular lesions in the STN 28,40 .…”

“…So, STN seems to be involved in the genesis of the main manifestations of PD. In fact, inactivation of STN has a profound benefic effect on practically all manifestations of the disease, both in humans and MPTP monkeys 1,3,4,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]35,36 . Another important aspect is the STN location within the basal ganglia circuitry: through its projections to the GPi, SNR and brainstem, it is in a unique position to influence the entire output of the basal ganglia 1,3,5,7-10 .…”

“…Some reports on surgical treatment of PD using targets in the subthalamic region (campotomy and subthalamotomy) showed that the dyskinesias are relatively infrequent complications, even when the STN itself was inadvertently lesioned 28,35 . Additionally, other publications demonstrated the significant improvement presented by parkinsonian patients who suffered from vascular lesions in the STN 28,40 .…”

“…Currently, according to a wide review of the literature 1,3,4,7,14,17,[26][27][28][29][30] , there are apparently only three groups performing STN lesioning: one group, composed of three subgroups, led by Alvarez, Obeso and DeLong 7,14,17,[26][27][28] ; another group, led by Gill & Heywood 29,30 ; and finally, our group, led by Vilela Filho & Silva 3,4 .…”

“…STN lesioning, on the other hand, was first reported by Obeso et al in 1997 26 . Probably due to the fear of producing hemiballismus, this procedure has been reported in only 21 patients all over the world 1,3,4,7,14,17,[26][27][28][29][30] , despite the significant improvement obtained.…”