Ventrolateral thalamotomy for dyskinesia following levodopa therapy of Parkinson's disease

We report a 65-year-old male parkinsonian patient who developed dominantly unilateral choreic movements over his right-side extremities after a daily dosage of up to 1,000 mg of carbidopa-levodopa (carbidopa 200 mg, levodopa 800 mg) for 12 years. The disabling choreic movement appeared as a pattern of peak-dose dyskinesia and was so severe that he was unable to sit or stand still to suppress the involuntary movements. It started about 20 minutes after each dose of levodopa and lasted for about 2 hours. Although the dyskinesia could be reduced by decreasing the levodopa dosage, he could not tolerate the severe parkinsonian disabilities. The dyskinesia did not respond to baclofen, diazepam or clozapine. The chorea was successfully treated surgically using stereotactic left ventrolateral thalamotomy. This is an important treatment for patients with intractable dyskinesia after prolonged levodopa therapy.