Prospective randomized one year follow up comparison of bilateral subthalamotomy versus bilateral subthalamic stimulation and the combination of both in Parkinson’s disease patients: A pilot study

MARCELO MERELLO; EDUARDO TENCA; SANTIAGO PEREZ-LLORET; MARÍA EUGENIA MARTN; VERÓNICA BRUNO; SOL CAVANAGH; JULIO ANTICO; RAMÓN LEIGUARDA; SANTIAGO PEREZ LLORET

British Journal of Neurosurgery

Informa Healthcare

Año: 2008 vol. 22 p. 415 - 421

Background: It has been suggested that potential risk of hemiballismus after subthalamotomy makes DBS preferable to ablation for IPD treatment; however, cost and need for regular electrode control have also been observed as disadvantages to stimulation. Objective: To compare efficacy and safety of different surgical approaches to STN, in a prospective randomized pilot study. Material and Methods: Sixteen consecutive IPD patients randomized to receive either: bilateral STN-DBS, bilateral subthalamotomy or unilateral subthalamotomy plus contralateral STN-DBS implantation, and followed for 12 months after surgery. One patient died and was excluded from the analysis. Results: Total and motor UPDRS scores as well as drug induced dyskinesias improved significantly at 1 year follow up, regardless of the procedure administered and without statistically significant differences between treatment modalities. Discrete changes were observed on ACE and MMSE scores. Psychiatric examination of patients subjected to bilateral stimulation and lesion, revealed slight increment in apathy and irritability scores, coinciding with significant deterioration of mentation, behaviour and mood as measured using the UPDRS. One patient presented persistent  hemiballismus and required ulterior postero-ventral pallidotomy. Conclusion: In this small group of patients, overall motor performance significantly improved after all three procedures, without major differences in outcome. Adverse events were nevertheless observed after both ablation and stimulation . The role of bilateral subthalamotomy in patients unable to receive an DBS electrode-implant merits further exploration in a larger series of patients.