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Academia Mexicana de Neurología, A.C.

2006, Number 6

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Rev Mex Neuroci 2006; 7 (6)

Lesional surgery as surgical treatment alternative in Parkinson’s disease. CIREN long-term experience

Pedroso II, Álvarez GL, Macías R, López FG, Rodríguez-Rojas R, Tejeiro AJ, Álvarez GE, Maragoto C, Padrón A, Díaz de la FA

Language: Spanish
References: 86
Page: 562-572
PDF size: 105.80 Kb.


ABSTRACT

Levodopa is a highly effective treatment of all motor symptoms of Parkinson’s disease. However, long-term treatment with levodopa can lead to motor fluctuations and levodopa-induced dyskinesias. Motor side effects can become so disabling that urge to explore other therapeutic alternatives. The current surgical treatment is aimed to control dysfunction of basal ganglia with ablative techniques, stimulation or reposition of dopaminergic neurons. The preferred alternative is the continuous brain deep stimulation by electric pulses but has limitations for its costs, complexity and specific complications. The functional lesion to basal ganglia could be a safe and effective alternative. Our 10 years of experience with lesion-making surgery using basal ganglia targets like ventralis intermedius thalamic nucleus, internal globus pallidus or dorsolateral subthalamic nucleus indicates benefits for a considerable group of surgical candidates. Here, we detailed the results obtained in 180 patients submmited to functional stereotactic procedures (52 VIM thalamotomies, 42 posteroventral palidotomies and 86 dorsolateral subthalamotomies) and compare techniques themselves and with DBS previously reports. The unilateral thalamotomy mainly improves tremor and is only usefull to treat tremorous dominant PD type, pallidotomy is indicated to improve all motor symptoms and levodopa-induced dyskinesias mainly in young onset, very dyskinetic PD patients and subthalamic nucleotomy is the most impacting technique to the disabling symptom: hypokinesia, which could be 50% decreased (reported by UPDRS section III). Simultaneously, levodopa intake is 40% reduced and effects lasted by 5 years after surgery. For that reason is the surgical choice to treat most of the patients with advanced PD caracteried by severe motor fluctuation and gait disorders. In conclusion, our experiences illustrated that functional steroeotactic neurosurgery remains as an efficacious alternative to treat complicated PD .


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