Ablative surgery in Parkinson's Disease: A Long-Term Follow-up of 18 Patients

Abstract

To evaluate the long-term effects of unilateral thalamotomy and pallidotomy inpatients with Parkinson's disease (PD). Eighteen patients with medically intractable PD(13 men, 5 women) underwent unilateral stereotactic ablative surgery (ventrolateralthalamotomy ar pallidotomy). The prominent and more disabling symptom was resting tremor in 14 thalamotomy patients but four patients treated with pallidotomy had alsa bradykinesia and motor fluctuations with "off' parkinsonism. Their mean age at the time of surgery was 54.67± 13.43 years (range, 30-75 yrs.), their mean age at the onset of the first symptom of PD was 44.39± 12.45 years (range, 23-69). The mean disease duration was 10.28±3.92 years and their mean follow-up period after surgery was 40.28± 11.18 months (range, 18-59 months). Eleven patients were at stage II, 4 patients were at stage III and 3 patients were at stage I. All patients were assesed at baseline preoperatively and in the first week, at 6, 12 and 24 months after surgery according ta UPDRS. When compared with preoperative baseline, significant improvements in mean UPDRS scores of the contralateral tremor, bradykinesia and rigidity were observed during the whole study period. The values at 24 month after surgery were as follows: bradykinesia (2.17± 1.04 vs 1.38±0.72; p=0.03), rigidity (1.78±0.94 vs 0.88±0.96; p=0.02) and tremor (2.33± 1.03 vs 0.50±0.89; p=0.001). There was a slight decrease in the mean daily dose of levodopa which was maintained for 2 years. Seven patients (38.89%) experienced transient adverse effects of minor type. Based on our long-term follow-up results, ablative surgery can be safely and effectively performed in medically intractable PD patients or in patients at advanced disease stage.