INVESTIGADORES
PEREZ LLORET Santiago
congresos y reuniones científicas
Título:
Prospective randomized comparison of bilateral subthalamotomy versus bilateral subthalamic stimulation and the combination of both in Parkinson’s disease patients: One year follow up.
Autor/es:
MARCELO MERELLO.; EDUARDO TENCA; SANTIAGO PÉREZ LLORET; RAMON LEIGUARDA
Lugar:
Kyoto
Reunión:
Congreso; Congreso Internacional de Movimientos Anormales; 2006
Resumen:
Objective: A prospective randomized study was therefore designed to compare efficacy and safety of these different surgical approaches to STN. Background:It has been suggested that risk of hemiballismus after subthalamotomy makes subthalamic nucleus stimulation  preferable to surgical ablation for Parkinson’s disease (IPD) treatment; however, cost, need for regular electrode replacement and tolerance have also been observed as disadvantages of stimulation. Material and Method: 16 consecutive patients suffering severe IPD were randomized to receive either bilateral subthalamic stimulation (BS), bilateral subthalamotomy (BL) or unilateral subthalamotomy plus contralateral stimulator implantation (L/S). Patients were evaluated 1 month before, and 6 and 12 months after surgery. One patient in the BS treated group who developed a deep brain haematoma was excluded from the analysis . Results: After each procedure total and motor UPDRS scores, as well as drug induced dyskinesias had improved significantly by 1 year of follow up,differences between the three surgical approaches were not statistically significant. Discrete changes on the ACE and MMSE were observed after all of the procedures. On psychiatric examination only patients under bilateral stimulation presented significant increment of apathy and irritability scores. After combined  surgery however, no permanent complications were observed. One patient from BL group  presented severe hemiballismus after surgery and required ulterior pallidotomy for complete resolution. Distribution of other reversible complications was similar between the three groups. Conclusion: Overall motor performance significantly improved after any of these procedure without major differences in results. Both ablation and stimulation could still cause a serious adverse event. Within this context the combined technique (L/E), with reduced procedure costs, less risk of hardware related complications as well as lower risk of hemiballismus and no psychiatric side effects probably represents  the best cost effective option for bilateral STN interventions.