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Long-term effect of unilateral subthalamotomy for Parkinson’s disease
  1. Yordanka Ricardo1,
  2. Nancy Pavon2,
  3. Lazaro Alvarez2,
  4. Enrique Casabona2,
  5. Juan Teijeiro2,
  6. Amado Díaz2,
  7. Carlos Maragoto2,
  8. Ivon Pedroso2,
  9. Ivan Garcia-Maeso3,
  10. Jorge Uriel Máñez-Miró4,
  11. Raul Martinez-Fernandez4,5,
  12. Raul Macias3,
  13. Jose Angel Obeso4,5
  1. 1 Movement Disorders, Centro Internacional de Restauración Neurologica (CIREN), La Habana, Cuba
  2. 2 Brain Images Processing Group and Movement Disorder Unit, International Center for Neurological Restoration, Havana, Cuba
  3. 3 Brain Images ProcessingGroup and Movement Disorder Unit, International Center for Neurological Restoration, Havana, Cuba
  4. 4 Movement Disorders, CINAC-Hospital Puerta del Sur, CEU San Pablo, Mostoles, Spain
  5. 5 Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
  1. Correspondence to Jose Angel Obeso, Movement Disorders, CINAC-Hospital Puerta del Sur, CEU San Pablo, Mostoles 28938, Spain; jobeso.hmcinac{at}hmhospitales.com

https://doi.org/10.1136/jnnp-2019-320523

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    Unilateral radiofrequency subthalamotomy has been shown to improve the cardinal features of Parkinson’s disease (PD).1 However, this approach has not been widely employed because most surgical candidates require bilateral treatment such as deep brain stimulation. Here, we evaluated to what extent the therapeutic impact of unilateral radiofrequency subthalamotomy on the treated body side is maintained years after surgery. This is particularly relevant nowadays because of the newly developed technique of MRI-guided high-intensity focused ultrasound (MRIgFUS). This has been shown to effectively improve essential and parkinsonian tremor by thalamotomy2 and all cardinal features of PD in asymmetrical patients by subthalamotomy.3

    Patients and methods

    See table 1 for demographic characteristics of the sample (n=7). All patients were recruited and operated on in the Centro Internacional de Restauración Neurologica (CIREN), Havana (Cuba), between 2008 and 2010. Details of the surgical procedure and clinical evaluation have been given previously.1 The Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III (Motor Part) was used for scoring. The specific impact of the lesion was evaluated by assessing the motor MDS-UPDRS score of the cardinal motor features for each body side (ie, 3.3 item for rigidity; 3.4–3.8 for bradykinesia and 3.15–3.17 for tremor). Patients were examined in the off medication state (12–18 hours of drug withdrawal) and subsequently re-evaluated after taking their usual levodopa dose. The same neurologists evaluated the patients reported here throughout the study period.

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    Table 1

    Baseline characteristics of patients with PD treated with unilateral subthalamotomy

    Results

    The …

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    Footnotes

    • Contributors YR, NP, JM, RMF and JAO analysed the clinical data. YR, RMF and JAO participated in the writing of the first draft of the manuscript. JAO is responsible for the whole content of the article. All authors planned the study, collected the clinical data and have read and agreed with the last version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval Institutional (CIREN) scientific ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.