Stereotactic surgical ablation of the thalamic nucleus (thalamotomy) has long been applied to parkinsonian tremor, rigidity, and levodopa induced dyskinesias.^1–3 Chronic high frequency deep brain stimulation (DBS) of the thalamus, the globus pallidus internus (GPi), and the subthalamic nucleus (STN) has been widely used as an alternative to ablative surgery in the treatment of Parkinson’s disease (PD). STN stimulation has become increasingly popular because it can result in a striking improvement of motor symptoms and the ability for PD patients to pursue the activities of daily living.⁴⁵ We report that STN stimulation markedly alleviated axial motor symptoms in a PD patient who had undergone bilateral thalamotomy more than 20 years earlier.

This 70 year old right handed woman presented for the first time to our university hospital in early 2002. Around 1968, she developed right sided tremor and bradykinesia and was diagnosed with PD. Although she initially responded well to medication, her symptoms progressed, with worsening motor fluctuations including dyskinesia. Left and right thalamotomy, performed in 1976 and 1982 respectively, resulted in marked improvement of her tremor and dyskinesia. She received optimised medication and for the next 10 years was able to continue her job as a secretary. However, she developed slowly worsening postural instability with hesitant and shuffling gait, and suffered occasional falls.

Admission examination in …