Stereotaxic Thalamotomy in the Management of Parkinson's Disease

ABSTRACT

A retrospective analysis was done on twenty-nine patients with Parkinson's disease who underwent thirty-five stereotaxic thalamotomies during the past 21 years. Eighteen patients received unilateral surgery, and six received two-staged bilateral surgery. Five had second stage operation after contralateral operation at other hospitals. Thirteen patients were followed-up for a period of six months to 12 years but the remainder were lost to follow-up. Parkinsonism scoring scale was designed and used to investigate postsurgical results and progress of patients. Clinical symptoms improved in 94.7% immediately after surgery. Only one patient had permanent neurological deficit resulting from the operation. A long-term follow-up study, with statistical analysis, suggested that progressive worsening after surgery was not ue to recurrence of tremor and rigidity but aggravation of bradykinesia and axial symptoms in the natural course of the disease. After unilateral surgery, 53.3% of patients had progressive aggravation of symptoms in contralateral side. It is believed that surgical treatment should be considered in patients presenting symptoms of tremor and rigidity. Bilateral surgery is indicated in patients who have bilateral symptoms or contralateral aggravation of symptoms after an initial operation.