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Therapeutic efficacy of unilateral subthalamotomy in Parkinson’s disease: results in 89 patients followed for up to 36 months
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  1. L Alvarez1,
  2. R Macias1,
  3. N Pavón1,
  4. G López1,
  5. M C Rodríguez-Oroz2,3,
  6. R Rodríguez1,
  7. M Alvarez1,
  8. I Pedroso1,
  9. J Teijeiro1,
  10. R Fernández1,
  11. E Casabona1,
  12. S Salazar1,
  13. C Maragoto1,
  14. M Carballo1,
  15. I García1,
  16. J Guridi2,3,
  17. J L Juncos4,
  18. M R DeLong4,
  19. J A Obeso2,3
  1. 1
    Movement Disorders, Functional Neurosurgery and Neurophysiology Units, Centro Internacional de Restauración Neurológica (CIREN), La Habana, Cuba
  2. 2
    Department of Neurology and Neurosurgery, Clínica Universitaria and Medical School and Neuroscience Division, CIMA, University of Navarra, Pamplona, Spain
  3. 3
    Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Pamplona, Spain
  4. 4
    Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Professor J A Obeso, Clínica Universitaria, Pio XII Avenue, 36, 31008 Pamplona, Spain; jobeso{at}unav.es

Abstract

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.

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Footnotes

  • 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.

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