Motor performance after posteroventral pallidotomy and VIM-thalamotomy in Parkinson's disease: a 1-year follow-up study

Twenty-three patients with Parkinson's disease underwent stereotactic surgery. To study the long-term motor performance, the patients were evaluated at the pre-operative period and at the 1st, 3rd, 6th, and 12th post-operative months, with the following scales: Unified Parkinson's Disease Rating Scale (UPDRS) motor score and Larsen's Scale for Dyskinesias. The patients under levodopa therapy were assessed both in "on" and "off" periods. Fourteen unilateral ventrolateral thalamotomies (VLT), 4 unilateral posteroventral pallidotomies (PVP), 2 bilateral PVP, and 3 VLT with contralateral PVP were performed. The motor improvement was significant and long-lasting in the "off" period, except for 2 patients. The "on" period quality improved, mainly due to the control of dyskinesias. The improvement of dyskinesias was long-lasting for the majority of the patients. There was no significant decrease in the levodopa dose. Three patients showed permanent complications, but none was severe

Talamotomia e palidotomia estereotáxica com planejamento computadorizado no tratamento da doença de Parkinson / Stereotaxic thalamotomy and pallidotomy with computerized planning in Parkinson's disease: short-term evaluation of motor function in 50 patients

Estudamos o desempenho motor de 50 pacientes com doença de Parkinson submetidos à cirurgia estereotáxica com planejamento computadorizado, sem ventriculografia (talamotomia ventro-lateral e/ou palidotomia póstero-ventral) antes e 1 mês após o procedimento cirúrgico. Foram realizadas 27 talamotomias ventro-laterais (TVL) unilaterais, 10 palidotomias póstero-ventrais (PPV) unilaterais, 6 PPV bilaterais, e 7 TVL associadas à PPV. A avaliaçao motora foi feita com a Escala Unificada para Doença de Parkinson, escore motor, nos períodos on e off. No total, houve melhora do escore motor em todos os grupos. A melhora das discinesias foi observada predominantemente no hemicorpo contralateral à cirurgia, no grupo das palidotomias. Dos 50 pacientes, 16 (32 por cento) apresentaram complicaçoes pós-operatórias, 9 destes (56,25 por cento) se recuperaram totalmente, 6 (37,25 por cento) mostraram melhora parcial, e 1 (6,25 por cento) nao apresentou melhora dentro do primeiro mês. Os resultados foram considerados satisfatórios, e a análise desses dados a longo prazo indicará se os benefícios sao duradouros.