Tags

Type your tag names separated by a space and hit enter

Bilateral subthalamotomy in Parkinson's disease: initial and long-term response.
Brain. 2005 Mar; 128(Pt 3):570-83.B

Abstract

We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12-24 months ('staged surgery'). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day ('simultaneous surgery'). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the 'off' and 'on' drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the 'off' (49.5%) and 'on' (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the 'off' and 'on' medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3-6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3-6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.

Authors+Show Affiliations

Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15689366

Citation

Alvarez, L, et al. "Bilateral Subthalamotomy in Parkinson's Disease: Initial and Long-term Response." Brain : a Journal of Neurology, vol. 128, no. Pt 3, 2005, pp. 570-83.
Alvarez L, Macias R, Lopez G, et al. Bilateral subthalamotomy in Parkinson's disease: initial and long-term response. Brain. 2005;128(Pt 3):570-83.
Alvarez, L., Macias, R., Lopez, G., Alvarez, E., Pavon, N., Rodriguez-Oroz, M. C., Juncos, J. L., Maragoto, C., Guridi, J., Litvan, I., Tolosa, E. S., Koller, W., Vitek, J., DeLong, M. R., & Obeso, J. A. (2005). Bilateral subthalamotomy in Parkinson's disease: initial and long-term response. Brain : a Journal of Neurology, 128(Pt 3), 570-83.
Alvarez L, et al. Bilateral Subthalamotomy in Parkinson's Disease: Initial and Long-term Response. Brain. 2005;128(Pt 3):570-83. PubMed PMID: 15689366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bilateral subthalamotomy in Parkinson's disease: initial and long-term response. AU - Alvarez,L, AU - Macias,R, AU - Lopez,G, AU - Alvarez,E, AU - Pavon,N, AU - Rodriguez-Oroz,M C, AU - Juncos,J L, AU - Maragoto,C, AU - Guridi,J, AU - Litvan,I, AU - Tolosa,E S, AU - Koller,W, AU - Vitek,J, AU - DeLong,M R, AU - Obeso,J A, Y1 - 2005/02/02/ PY - 2005/2/4/pubmed PY - 2005/3/29/medline PY - 2005/2/4/entrez SP - 570 EP - 83 JF - Brain : a journal of neurology JO - Brain VL - 128 IS - Pt 3 N2 - We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12-24 months ('staged surgery'). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day ('simultaneous surgery'). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the 'off' and 'on' drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the 'off' (49.5%) and 'on' (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the 'off' and 'on' medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3-6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3-6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory. SN - 1460-2156 UR - https://www.unboundmedicine.com/medline/citation/15689366/Bilateral_subthalamotomy_in_Parkinson's_disease:_initial_and_long_term_response_ L2 - https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awh397 DB - PRIME DP - Unbound Medicine ER -