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Subthalamotomy for advanced Parkinson disease.
J Neurosurg. 2002 Sep; 97(3):598-606.JN

Abstract

OBJECT

The aim of this study was to determine if subthalamotomy is effective in treating advanced Parkinson disease (PD).

METHODS

The authors performed microelectrode mapping-guided stereotactic surgery on the subthalamic nucleus in eight patients with PD. Lesioning was performed using radiofrequency heat coagulation and confirmed with magnetic resonance imaging. Three patients who underwent unilateral and four with bilateral subthalamotomy were evaluated for up to 18 months according to the Unified PD Rating Scale (UPDRS). One patient who underwent unilateral subthalamotomy died 6 months postsurgery. At 3 months into the "off" period after surgery, there were significant improvements in contralateral bradykinesia (p < 0.0002), rigidity (p < 0.0001), tremor (p < 0.01), axial motor features (p < 0.02), gait (p < 0.03), postural stability (p < 0.03), total UPDRS scores (p < 0.03), and Schwab and England scores (p < 0.04). The benefits were sustained at 6, 12, and 18 months, except for the improvement in tremor. At 12 months into the "on" period, significant benefits were present for motor fluctuation (p < 0.04), on dyskinesia (p < 0.006), off duration (p < 0.05), total UPDRS score (p < 0.02), and contralateral tremor (p < 0.05). Benefits for motor fluctuation, off duration, and off-period tremor were lost after the 18-month follow-up period. The levodopa requirement was reduced by 66% for the unilateral and 38% for the bilaterally treated group. Bilateral subthalamotomy offered more benefits than did unilateral surgery for various parkinsonian features in both the on and off periods. Three patients suffered hemiballismus, two recovered spontaneously, and one died of aspiration pneumonia after discontinuation of levodopa.

CONCLUSIONS

These findings indicate that subthalamotomy can ameliorate the cardinal symptoms of PD, reduce the dosage of levodopa, diminish complications of the drug therapy, and improve the quality of life.

Authors+Show Affiliations

Department of Neurology, National Taiwan University Hospital, Taipei, ROC. philipsu@ha.mc.ntu.edu.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

12296644

Citation

Su, Philip C., et al. "Subthalamotomy for Advanced Parkinson Disease." Journal of Neurosurgery, vol. 97, no. 3, 2002, pp. 598-606.
Su PC, Tseng HM, Liu HM, et al. Subthalamotomy for advanced Parkinson disease. J Neurosurg. 2002;97(3):598-606.
Su, P. C., Tseng, H. M., Liu, H. M., Yen, R. F., & Liou, H. H. (2002). Subthalamotomy for advanced Parkinson disease. Journal of Neurosurgery, 97(3), 598-606.
Su PC, et al. Subthalamotomy for Advanced Parkinson Disease. J Neurosurg. 2002;97(3):598-606. PubMed PMID: 12296644.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subthalamotomy for advanced Parkinson disease. AU - Su,Philip C, AU - Tseng,Ham-Min, AU - Liu,Hon-Man, AU - Yen,Ruoh-Fang, AU - Liou,Horng-Huei, PY - 2002/9/26/pubmed PY - 2002/10/12/medline PY - 2002/9/26/entrez SP - 598 EP - 606 JF - Journal of neurosurgery JO - J Neurosurg VL - 97 IS - 3 N2 - OBJECT: The aim of this study was to determine if subthalamotomy is effective in treating advanced Parkinson disease (PD). METHODS: The authors performed microelectrode mapping-guided stereotactic surgery on the subthalamic nucleus in eight patients with PD. Lesioning was performed using radiofrequency heat coagulation and confirmed with magnetic resonance imaging. Three patients who underwent unilateral and four with bilateral subthalamotomy were evaluated for up to 18 months according to the Unified PD Rating Scale (UPDRS). One patient who underwent unilateral subthalamotomy died 6 months postsurgery. At 3 months into the "off" period after surgery, there were significant improvements in contralateral bradykinesia (p < 0.0002), rigidity (p < 0.0001), tremor (p < 0.01), axial motor features (p < 0.02), gait (p < 0.03), postural stability (p < 0.03), total UPDRS scores (p < 0.03), and Schwab and England scores (p < 0.04). The benefits were sustained at 6, 12, and 18 months, except for the improvement in tremor. At 12 months into the "on" period, significant benefits were present for motor fluctuation (p < 0.04), on dyskinesia (p < 0.006), off duration (p < 0.05), total UPDRS score (p < 0.02), and contralateral tremor (p < 0.05). Benefits for motor fluctuation, off duration, and off-period tremor were lost after the 18-month follow-up period. The levodopa requirement was reduced by 66% for the unilateral and 38% for the bilaterally treated group. Bilateral subthalamotomy offered more benefits than did unilateral surgery for various parkinsonian features in both the on and off periods. Three patients suffered hemiballismus, two recovered spontaneously, and one died of aspiration pneumonia after discontinuation of levodopa. CONCLUSIONS: These findings indicate that subthalamotomy can ameliorate the cardinal symptoms of PD, reduce the dosage of levodopa, diminish complications of the drug therapy, and improve the quality of life. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/12296644/Subthalamotomy_for_advanced_Parkinson_disease_ L2 - https://thejns.org/doi/10.3171/jns.2002.97.3.0598 DB - PRIME DP - Unbound Medicine ER -