Is unilateral stereotactic thalamotomy only useful for contralateral tremor?
DOI:
https://doi.org/10.47924/neurotarget20216Keywords:
Bradykinesia, Parkinson´s disease, Rigidity, Thalamotomy, TremorAbstract
Introduction: Unilateral thalamotomy is used in patients with Parkinson's disease (PD) and disabling unilateral tremor, refractory to medication. Benefits of this type of surgery have been reported on stiffness and bradykinesia contralateral to the surgical procedure. The objective of this work is to quantify the results of unilateral thalamotomy on tremor, bradykinesia and rigidity, both contralateral and ipsilateral to the lesion, in patients with idiopathic PD.
Material and Methods: Nine patients who received unilateral thalamotomy in the ventral intermediate nucleus were evaluated in our center. The scores obtained on the UPDRS III scales OFF medication before and after surgery were compared.
Results: Contralateral resting tremor had an overall improvement of 87%, the sum of all types of tremor improved 83.13%, and contralateral bradykinesia 32%, with a statistically significant difference in medians between groups. Contralateral stiffness improved by 29% but the difference was not signifycant. The ipsilateral symptoms worsened during follow-up.
Discussion: Although the benefit of this procedure on contralateral tremor is widely known, it is remarkable that the results on rigidity and bradykinesia have had little mention in recent years.
Conclusions: Unilateral thalamotomy could be a useful tool not only for tremor control, but also for the management of rigid-akinetic symptoms in patients with contraindications or difficulties in access to deep brain stimulation.
Metrics
References
Obeso, J A, Guridi, & DeLong M. Surgery forParkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry. 1997; 62(1): 2–8. doi:10.1136/jnnp.62.1.2
Mosso, J A, Rand R W. “Management ofparkinson's disease-combined therapy with levodopa and thalamotomy.” The Western journal of medicine. 1975; 122(1): 1-6.
Dwarakanath S, Zafar A, Yadav R, et al. Doeslesioning surgery have a role in the management of multietiological tremor in the era of Deep Brain Stimulation? Clinical Neurology and Neurosurgery. 2014; 125:131–136. doi:10.1016/j.clineuro.2014.07.016
Speelman, J D, Schuurman R, de Bie R M A, et al. Stereotactic neurosurgery for tremor. Movement Disorders. 2002; 17(S3), S84–S88. doi:10.1002/mds.10147.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 María Laura Contartese, Sebastián Rodríguez, Julieta Casen, José Luis Etcheverry, Nicolás Barbosa, Sergio Pampin, Fabián Piedimonte
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
