Effect of the combination pallidotomy-subthalamotomy performed in opposite cerebral hemispheres for the treatment of motor signs in Parkinson's disease.

Abstract

Introduction: Functional Neurosurgery constitutes a therapeutic alternative for patients with Parkinson's Disease (PD). It is known that both bilateral subthalamotomy and bilateral pallidotomy cause neurological complications, so in ablative techniques a bilateral approach to the GPi is not recommended in PD and caution is suggested with the indication of bilateral subthalamotomy. Our group has refined the surgical technique for the ablation of the subthalamic nucleus seeking to reduce the appearance of dyskinesias induced by surgery and obtain a better therapeutic effect, so the approach to the NST in a second surgical procedure in the opposite hemisphere to the one performed previously pallidotomy, would avoid the complications derived from bilateral pallidotomy and can be a safe alternative for patients even when they present symptoms of dyskinesias. We set out to evaluate the effect and safety of the combination of GPi and NST lesion in opposite cerebral hemispheres in PD patients.

Method: A retrospective study was carried out that included all patients operated on at the CIREN in a period of 22 years, who underwent a pallidotomy contralateral to the most affected hemibody; followed by a subthalamotomy of the opposite hemisphere in a second surgical procedure. The effect on the neurological condition was evaluated using section III of the MDS-UPDRS scale. Safety was evaluated according to the adverse effects scale and the Clavien and Dindo scale.

Results: Both surgical interventions had a positive impact on the patients' pharmacological treatment, significantly reducing the doses of L-dopa. A significant improvement was observed in the motor condition of the patients in relation to dyskinesias, as well as rigidity, bradykinesia and tremor.

Conclusions: The pallidotomy/subthalamotomy combination showed to be an effective alternative for the treatment of complicated PD, capable of allowing better motor control and a reduction in the dose of L-Dopa with a low rate of complications; it also allows to avoid complications derived from bilateral pallidotomy and subthalamotomy, proving to be a safe alternative for patients even when they present symptoms of dyskinesias.