Bilateral subthalamotomy for advanced Parkinson disease

Area of Science:

• Neurosurgery
• Neurology
• Movement Disorders

Background:

• Unilateral subthalamotomy improves rigidity, bradykinesia, and tremor in Parkinson's disease (PD).
• Long-term benefits of unilateral STN lesioning are limited for gait, clinical fluctuation, and postural stability.
• Investigating bilateral subthalamotomy for advanced PD is crucial.

Purpose of the Study:

• To evaluate the efficacy of bilateral subthalamotomy in treating advanced Parkinson's disease.
• To assess long-term outcomes of staged bilateral STN surgery.

Main Methods:

• Bilateral radiofrequency thermal coagulation of the subthalamic nucleus (STN) in 10 advanced PD patients.
• Surgery performed in stages under microelectrode and stereotactic guidance, targeting the dorsolateral STN.
• Median follow-up of 26 months (range 6-48 months) with pre- and post-operative UPDRS assessments.

Main Results:

• Persistent improvements in bradykinesia, rigidity, daily living activities, and motor function.
• Significant enhancements in axial motor features, gait, postural stability, and clinical fluctuations.
• Sustained benefits up to 36 months, with a 34% reduction in l-dopa equivalent; no speech impairment observed.

Conclusions:

• Staged bilateral subthalamotomy is a safe and effective long-term treatment for advanced PD.
• This approach benefits patients with bilateral symptoms, axial impairment, or clinical fluctuations.
• The procedure demonstrates sustained efficacy in improving motor and non-motor symptoms.