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Pallidothalamic Tractotomy for Parkinson Disease with 1-Year Follow-Up: A Case Report.
World Neurosurg 2019; 121:193-195WN

Abstract

BACKGROUND

The pallidothalamic tract connects the globus pallidus internus and the ventrolateral portion of the thalamus, and ablation of the pallidothalamic tract (pallidothalamic tractotomy [PTT]) reportedly exerts antiparkinsonian effects. However, the detailed clinical course has not yet been elucidated. Here, we present the first single case report of PTT performed in a patient with Parkinson disease, with 1-year follow-up.

CASE DESCRIPTION

The patient was a 68-year-old woman with Parkinson disease. After 14 years of receiving oral medication, she experienced the "wearing-off" phenomenon. Levodopa (300 mg/day) was required to maintain daily activities. Rigidity and peak-dose dyskinesia were predominantly observed in the right side of her body. In addition, she demonstrated right foot dystonia with pain. The preoperative Unified Parkinson Disease Rating Scale part 1, 2 (off medication/on medication), 3 (off medication/on medication), and 4 scores were 7, 26/4, 41/23, and 13, respectively. Further, the preoperative Unified Dyskinesia Rating Scale and Parkinson Disease Questionnaire-39 scores were 102 and 46, respectively. She underwent left-sided PTT, and no perioperative complications were observed. At 1 year postoperatively, daily administration of levodopa (200 mg) was maintained without an "off" condition all day. The 1-year Unified Parkinson Disease Rating Scale part 1, 2, 3, and 4 scores were 5, 9/1, 20/12, and 5, respectively. In addition, the 1-year Unified Dyskinesia Rating Scale and Parkinson Disease Questionnaire-39 scores were 20 and 20, respectively.

CONCLUSIONS

We present a rare case of PTT performed in a patient with Parkinson disease. PTT might be useful in patients who do not desire device implantation.

Authors+Show Affiliations

Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: neurosurgery21@yahoo.co.jp.School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30336294

Citation

Horisawa, Shiro, et al. "Pallidothalamic Tractotomy for Parkinson Disease With 1-Year Follow-Up: a Case Report." World Neurosurgery, vol. 121, 2019, pp. 193-195.
Horisawa S, Nanke M, Kawamata T, et al. Pallidothalamic Tractotomy for Parkinson Disease with 1-Year Follow-Up: A Case Report. World Neurosurg. 2019;121:193-195.
Horisawa, S., Nanke, M., Kawamata, T., & Taira, T. (2019). Pallidothalamic Tractotomy for Parkinson Disease with 1-Year Follow-Up: A Case Report. World Neurosurgery, 121, pp. 193-195. doi:10.1016/j.wneu.2018.10.055.
Horisawa S, et al. Pallidothalamic Tractotomy for Parkinson Disease With 1-Year Follow-Up: a Case Report. World Neurosurg. 2019;121:193-195. PubMed PMID: 30336294.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pallidothalamic Tractotomy for Parkinson Disease with 1-Year Follow-Up: A Case Report. AU - Horisawa,Shiro, AU - Nanke,Magi, AU - Kawamata,Takakazu, AU - Taira,Takaomi, Y1 - 2018/10/15/ PY - 2018/06/25/received PY - 2018/10/05/revised PY - 2018/10/07/accepted PY - 2018/10/20/pubmed PY - 2019/1/18/medline PY - 2018/10/19/entrez KW - Campotomy KW - Pallidothalamic tract KW - Parkinson disease SP - 193 EP - 195 JF - World neurosurgery JO - World Neurosurg VL - 121 N2 - BACKGROUND: The pallidothalamic tract connects the globus pallidus internus and the ventrolateral portion of the thalamus, and ablation of the pallidothalamic tract (pallidothalamic tractotomy [PTT]) reportedly exerts antiparkinsonian effects. However, the detailed clinical course has not yet been elucidated. Here, we present the first single case report of PTT performed in a patient with Parkinson disease, with 1-year follow-up. CASE DESCRIPTION: The patient was a 68-year-old woman with Parkinson disease. After 14 years of receiving oral medication, she experienced the "wearing-off" phenomenon. Levodopa (300 mg/day) was required to maintain daily activities. Rigidity and peak-dose dyskinesia were predominantly observed in the right side of her body. In addition, she demonstrated right foot dystonia with pain. The preoperative Unified Parkinson Disease Rating Scale part 1, 2 (off medication/on medication), 3 (off medication/on medication), and 4 scores were 7, 26/4, 41/23, and 13, respectively. Further, the preoperative Unified Dyskinesia Rating Scale and Parkinson Disease Questionnaire-39 scores were 102 and 46, respectively. She underwent left-sided PTT, and no perioperative complications were observed. At 1 year postoperatively, daily administration of levodopa (200 mg) was maintained without an "off" condition all day. The 1-year Unified Parkinson Disease Rating Scale part 1, 2, 3, and 4 scores were 5, 9/1, 20/12, and 5, respectively. In addition, the 1-year Unified Dyskinesia Rating Scale and Parkinson Disease Questionnaire-39 scores were 20 and 20, respectively. CONCLUSIONS: We present a rare case of PTT performed in a patient with Parkinson disease. PTT might be useful in patients who do not desire device implantation. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30336294/Pallidothalamic_Tractotomy_for_Parkinson_Disease_with_1-Year_Follow-Up:_A_Case_Report L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)32352-0 DB - PRIME DP - Unbound Medicine ER -