Is there a place for pallidotomy in the modern treatment of parkinsons disease?

Abstract

Objective – to determine the clinical significance of unilateral stereotactic radiofrequency pallidotomy (USRP) in patients with Parkinson's disease (PD) complicated by levodopa-induced dyskinesias (LID) and motor fluctuations (MF) one week and then one year after surgery.

Materials and methods. From 2008 to 2016 USRP was performed in 16 patients (7 men and 9 women from 48 to 73 years old, average – 56 years) with PD complicated by LID and MF. The dynamics of the disease symptoms was interpreted on the basis of separate sections and points of the UPDRS.

Results. The overall severity of contralateral LIDs decreased by 87.8 % one week after USRP, and after 1 year the difference compared with preoperative status was 85.4 %. According the assessment of axial dyskinesia, the values of the relevant indicators were 65.3 % and 42.0 %. Ipsilateral LIDs after USRP decreased by 25.0 %, but at the time of the control over the year, their severity even increased by 10.0 % compared to the preoperative level. A week after pallidotomy, a decrease in the expression of motor fluctuations was noted at 32.2 %, however, after a year this figure was 12.0 %. In assessing the effect of USRP on the separate symptoms of the OFF period of the PD, the contralateral rest tremor decreased by 70.0 % after week, and 60 % after a year of follow up. The decrease in the severity of contralateral rigidity the week after operation was noted at 71.4 %, and after a year of observation, this figure did not change significantly. The severity of contralateral hypokinesia decreased by 28.6 % in one week and 14.3 % in one year after pallidotomy. Ipsilateral tremor, rigidity and hypokinesia did not respond to intervention in any way, and, based on the results of the control, progressed insignificantly, which can be explained by the general progression of the disease. There was no positive or negative effect of USRP on postural instability. Transient speech disorders were found in 2 (12.5 %) cases. In 2 (12.5 %) patients contralateral paresis of facial muscle was observed.

Conclusions. The control of contralateral LID, which has been observed for at least one year after surgery is the most prominent effect of USRP for PD. Positive effects on axial dyskinesias are partly depleted one year after the operation, while the effects on the ipsilateral LID are negligible and impermanent. The effects on motor fluctuations are moderately expiring during the year. The perceptible and persistent effects of USRP on contralateral tremor, rigidity and hypokinesia was observed. The symptoms of neurological deficitis after USRP are transient.