[SURGICAL TREATMENT OF PARKINSON'S DISEASE WITH LEVODOPA-INDUCED MOVEMENT DISTURBANCES].

Aim - to evaluate the efficacy of stereotactic pallidotomy and bilateral deep brain stimulation (DBS) of subthalamic nuclei (STN) in patients with Parkinson disease with motor fluctuations and levodopa-induced dyskinesias. 36 patients (age range 31-73 years (mean age 56.2±3.2 years) were enrolled in study. Mean duration of PD was 9.8±1.1years. All patients used levodopa-drugs, mean levodopa dose was 1075±304.1 mg/day. Mean duration of motor fluctuations and levodopa-induced dyskinesias before surgery was 2,18±0,8 years. Patients = were divided into 2 groups - 22 patients underwent stereotactic unilateral pallidotomy and 14 patients underwent bilateral DBS (STN target). Neurological and psychological status assessed before and after treatment by: UPDRS II, Hoehn and Yahr scale, Schwab and England scale, MMSE, Beck's Depression Inventory, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and PDQ-39. Surgery performed on CRW stereotactic system. Postoperative follow-upranged from 1 to 8.5 years (mean 4.1±1.1 years). Regression of tremor, rigidity, bradykinesia and levodopa-induced dyskinesia observed in most patients after stereotactic interventions. The best results were achieved in patients who underwent DBS. In this group UPDRS II score improved by 74% in ON period and by 63% in OFF period. After pallidotomy UPDRS II score improved by 55% in ON period and by 47% in OFF period. Levodopa-induced dyskinesia stopped in 21 from 22 (95.5%) patients who had it before surgery after unilateral pallidotomy and in 11 from 12 (91.7%) patients after DBS. Surgical complications occurred in 3 (13.6%) case after pallidotomy, which induced transient neurological deficit. Our results demonstrate that both stereotactic interventions - pallidotomy and DBS are effective and safe methods of treatment of PD with levodopa-induced dyskinesias and motor fluctuations. Both surgeries improve overall motor function, increased patient's mobility and improve quality of life.

[STEREOTACTIC THALAMOTOMY AND CONTRALATERAL SUBTHALAMOTOMY IN TREATMENT OF PARKINSON'S DISEASE].

Aim - to evaluate the efficacy of combined bilateral stereotactic destruction of subcortical nucleus - thalamotomy and contralateral subthalamotomy in patients with Parkinson disease. The study included 10 patients with PD, aged 54-73 (mean age 61.1±5.2 years). The time between two surgeries ranged from 1 to 5 years (mean 2.5±0.5 years). The surgeries were conducted on CRW Radionics stereotactic system using StereoPlan, Atlas (Radionics) andFraimLink (Medtronic) software for target calculating. The neuropsychological status was assessed by UPDRS II, Hoehn and Yahr scale, Schwab and England scale, MMSE. The postoperative follow-up was from 6 months to 5.5 years (mean 3.2±0.9 years). After surgeries tremor stopped or significantly regressed in 9 (90.0%) patients, muscle tone returned to normal in 8 (80.0%) cases and in 7 (70.0%) bradykinesia partially regressed. The increase of motor activity was observed in 8 (80.0%) patients. Levodopa-induced dyskinesia stopped in 5 (50.0%) patients and motor fluctuations regressed in 4 of 5 (80.0%) patients. After the surgery the dose of levodopa decreased on average by 36% - from 885±245 mg/day to 570±165 mg/day. The indices of Schwab and England Activities of daily living improved from 56.1% to 80.7%. The postoperative complications were observed in2 (20.0%) cases. Our results demonstrate that bilateral ablative surgery is an effective and safe method of treatment of PD. Stereotactic radiofrequency thalamotomy and contralateral subthalamotomyimprove overall motor function, increase patient's mobility, allow patients to reduce levodopa dose and improve the quality of life.