Long-Term Follow-Up Results of Bilateral Thalamotomy for Parkinsonism

Abstract

27 patients who underwent bilateral thalamotomy for parkinsonism over the past 10 years have been clinically evaluated. Mean follow-up period was 6.2 years after second surgery. In these cases, 8 returned to full social life without any medication, 4 were capable of social life with medical treatment, 6 were self-sufficient and 3 were semi-selfsufficient in ADL, respectively. Therapeutic drug doses were reduced in all cases. L-Dopa-induced dyskinesia was not observed after second surgery. Speech disturbance, which was not severe, was recognized in 12 cases as a complication.

A Comparison of Continuous Thalamic Stimulation and Thalamotomy for Suppression of Severe Tremor

“…[1][2][3][4][5][6] However, this procedure is accompanied by permanent complications in 9 to 23 percent of patients with Parkinson's disease or essential tremor 1,2,5-8 and in 16 to 41 percent of patients with multiple sclerosis. 7,9,10 Bilateral thalamotomy carries an even higher risk [11][12][13] and is no longer recommended. 14 Continuous deep-brain stimulation through an electrode implanted in the thalamus is an alternative to ablative surgery.…”

“…For patients with bilateral tremor, we chose to compare unilateral thalamotomy with bilateral stimulation because bilateral thalamotomy is no longer used in clinical practice 11,12 and because the results of bilateral stimulation should reflect the full potential of this approach. The average difference in functional gain between the thalamic-stimulation group and the thalamotomy group was similar in the patients with bilateral tremor and in those with unilateral tremor because of the effect on the analysis of the perioperative death of one patient.…”

Ipsilateral Thalamic Stimulation after Thalamotomy for Essential Tremor

“…Thalamotomy has been performed for decades to control severe tremor [5,6]. While unilateral thalamotomy is often successful, bilateral surgeries have been limited by risk of dysphagia, dysarthria, and neuropsychological abnormalities [7,8]. In some cases, the procedure provides only temporary tremor suppression necessitating recurrent surgery in approximately 7-27% of patients [8][9][10].…”

Investigation into experimental toxicological properties of plant protection products having a potential link to Parkinson's disease and childhood leukaemia†

“…Injection of adeno/lenti-associated virus that expresses wild-type or mutant a-syn into rat, mice or non-human primate SN produced loss of dopaminergic neurons, but the effect is not easily reproduced in transgenic mice overexpressing alpha-synuclein Rationale for the role of autophagy: Early dendritic and axonal dystrophy, reduction of striatal dopamine content, and the formation of somatic and dendritic ubiquitinated inclusions in DA neurons were prevented by ablation of Atg7 (an essential autophagy gene ) Rationale for the role of UPS/ALP: Protection from DA neuronal death was also observed in multiple experiments through the pharmacological modulation of the UPS, ALP system; however, there are also contradicting data in the literature Zhu et al, 2007; However, although many lines of evidence exist to support essentiality of impaired proteostasis, a single molecular chain of events cannot be established Clinical and experimental evidences show that the pharmacological replacement of the DA neurofunction by allografting fetal ventral mesencephalic tissues is successfully replacing degenerated DA neurons resulting in the total reversibility of motor deficit in animal model and partial effect is observed in human patient for PD Lopez-Lozano et al, 1991; Also, administration of L-DOPA or DA agonists results in an improvement of motor deficits . The success of these therapies in man as well as in experimental animal models clearly confirms the causal role of dopamine depletion for PD motor symptoms (Cotzias et al, 1969;Matsumoto et al, 1976;Narabayashi et al, 1984;Kelly et al, 1987;Lopez-Lozano et al, 1991;Uitti et al, 1996Uitti et al, , 1997Silva et al, 1997;Lang et al 1998;Scott et al, 1998;De Bie et al, 1999;Walter et al, 2004;...…”