Involuntary movements following stereotactic operations for Parkinsonism with special reference to hemi-chorea (ballismus)

Subthalamic nucleotomy alleviates parkinsonism in the 1 -methyl-4-phenyl-1,2,3,6- tetrahydropyridine (MPTP)-exposed primate

“…This is not surprising as abnormal involuntary movements seen with vascular lesions of the S T N are usually ~elf-limiting,3~ as are also those secondary to movement disorder surgery in man. 36 In the past there have been reports of excellent symptom reversal following medial pallidotomy. I 8*37 This is not inconsistent with our findings.…”

Hemiballismus Complicating Stereotactic Thalamotomy

“…The incidence of this complication, however, is higher when the lesions are placed below the intercommissural line [4,16] and in the anterolateral subthalamus [2], It has been noted also that hyperki nesis occurs more frequently after bilateral thalamic surgery [12] and may involve the limbs ipsilateral to the cerebral lesion after unilateral [5] or bilateral operation [8,30]. It may also be significant that hemiballismus has never been reported to complicate surgery for dyskinesias of nonpar kinsonian origin.…”

“…The onset of the hyperkinesia was noted as early as minutes and as late as 1 month following surgery. Delayed appearance of involuntary movements, even 2'U years after sur gery, was reported by Hughes [16] in 3 patients of whom 2 were posten cephalitic parkinsonians. The occurrence of the hyperkinesia did not pre vent good therapeutic results on the preexisting tremor and rigidity [5,12,14].…”

“…In describing the postoperative involuntary movements, the terms hemichorea and hemiballismus were used quite interchangeably by var ious authors. It is the opinion of Martin [25], Dierssen and Gioino [9] and Hughes [16] and many others that the difference between the two hy perkinetic syndromes is quantitative rather than qualitative and they are clinical deviants of the same phenomenon and not the expression of dys function of different cerebral structures. The onset of the hyperkinesia was noted as early as minutes and as late as 1 month following surgery.…”

Treatment of hemiballismus with stereotactic pallidotomy

“…29,36 Hemiballismus was also encountered in patients who had suffered head trauma 8,36 and after they had undergone thalamotomies and subthalamotomies for tremor control. 4,13,16,24,34 In the past, the prognosis for hemiballismus was uniformly grave, 33,50 and this fact prompted development of various surgical procedures for control of the disease. The operations proposed for this purpose included limb amputation and brachial plexus destruction, 33,38 cortical resection, 2,7,33 anterior cervical cordotomy, 6,42 and pedunculotomy.…”