Therapeutic efficacy of unilateral subthalamotomy in Parkinson’s disease: results in 89 patients followed for up to 36 months
- L Alvarez1,
- R Macias1,
- N Pavón1,
- G López1,
- M C Rodríguez-Oroz2,3,
- R Rodríguez1,
- M Alvarez1,
- I Pedroso1,
- J Teijeiro1,
- R Fernández1,
- E Casabona1,
- S Salazar1,
- C Maragoto1,
- M Carballo1,
- I García1,
- J Guridi2,3,
- J L Juncos4,
- M R DeLong4,
- J A Obeso2,3
- 1Movement Disorders, Functional Neurosurgery and Neurophysiology Units, Centro Internacional de Restauración Neurológica (CIREN), La Habana, Cuba
- 2Department of Neurology and Neurosurgery, Clínica Universitaria and Medical School and Neuroscience Division, CIMA, University of Navarra, Pamplona, Spain
- 3Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Pamplona, Spain
- 4Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Correspondence to Professor J A Obeso, Clínica Universitaria, Pio XII Avenue, 36, 31008 Pamplona, Spain;
- Received 30 June 2008
- Revised 7 November 2008
- Accepted 25 November 2008
- Published Online First 9 February 2009
Background: Stereotactic thermocoagulative lesions of the subthalamic nucleus (STN) have been shown to induce significant motor improvement in patients with Parkinson’s disease (PD).
Patients and methods: 89 patients with PD were treated with unilateral subthalamotomy. 68 patients were available for evaluations after 12 months, 36 at 24 months and 25 at 36 months.
Results: The Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores improved significantly contralaterally to the lesion in the “off” and “on” states throughout the follow-up, except for the “on” state at the last evaluation. Axial features and signs ipsilateral to the lesion progressed steadily throughout the study. Levodopa daily doses were significantly reduced by 45%, 36% and 28% at 12, 24 and 36 months post-surgery. 14 patients (15%) developed postoperative hemichorea-ballism which required pallidotomy in eight. These 14 patients had significantly higher dyskinesia scores (levodopa induced) preoperatively than the entire cohort.
Conclusion: Unilateral subthalamotomy was associated with significant and sustained motor benefit contralateral to the lesion. Further work is needed to ascertain what factors led to severe, persistent chorea-ballism in a subset of patients. Subthalamotomy may be considered an option in circumstances when deep brain stimulation is not viable.
Competing interests None.
See Editorial Commentary, p 939
Ethics approval The study was approved by the institutional scientific committee and the Cuban National Ethics Committee.