Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

Abstract

Parkinson's disease (PD) is a neurodegenerative condition that can be pharmacologically treated with levodopa. However, important motor and nonmotor symptoms appear with its long-term use. The subthalamic nucleus (STN) is known to be involved in the pathophysiology of PD and to contribute to levodopa-induced complications. Surgery is considered in patients who have advanced PD that is refractory to pharmacotherapy and who display disabling dyskinesia. Deep brain stimulation of the STN is currently the main surgical procedure for PD, but lesioning is still performed. This review covers the clinical aspects and complications of subthalamotomy as one of the lesion-based options for PD patients with levodopa-induced dyskinesias. Moreover, the authors discuss the possible effects of subthalamic lesioning.

Ablative surgery for Parkinson’s disease: Is there still a role for pallidotomy in the deep brain stimulation era?

“…Even though it shows similar efficacy and possible benefits over pallidotomy [47,48], there is a well-known chance of permanent hemiballism as a consequence of the surgery. In this regard, Alvarez et al demonstrated in their series that 15% of the patients developed postoperative hemichorea-ballism [49].…”

Subthalamotomy-induced changes in dopamine receptors in parkinsonian monkeys

“…Subthalamotomy abolishes the overactive subthalamopallidal excitatory outflow (Bergman et al, 1994) and that results in motor improvements in PD patients in both "ONmedication" and "OFF-medication" states (Jourdain et al, 2014). Furthermore, PD patients may see their dopaminergic medication reduced by 45% in the first year and 30% after two years (Jourdain et al, 2014).…”

“…Subthalamotomy abolishes the overactive subthalamopallidal excitatory outflow (Bergman et al, 1994) and that results in motor improvements in PD patients in both "ONmedication" and "OFF-medication" states (Jourdain et al, 2014). Furthermore, PD patients may see their dopaminergic medication reduced by 45% in the first year and 30% after two years (Jourdain et al, 2014). When keeping the same L-DOPA daily dose after subthalamotomy, patients had a better motor response and spent more time "ON-medication", indicative of a beneficial effect on wearing-off (Alvarez et al, 2001).…”

The Use of Magnetic Resonance Imaging-guided Focused Ultrasound in Movement Disorders—A Review

“…Side effects from unilateral STN ablation can include hemiballismus/hemichorea and postural instability, though these are typically transient. 27 The effects of FUS on the STN are unclear at this time but multiple trials are currently under way to explore this (ClinicalTrials.gov Identifiers: NCT02003248 and NCT02252380). As of yet, there are no published preliminary data from these studies available.…”