Thalamotomy, pallidotomy and subthalamotomy in the management of Parkinson's disease

MALCO ROSSI; DANIEL CERQUETTI; JORGE MANDOLESI; MARCELO MERELLO

Parkinson's Disease - Current and Future Therapeutics and Clinical Trials

Cambridge University Press

Lugar: Cambridge; Año: 2016; p. 1 - 2

In the last few decades, there has been a revival of ablative and stimulation surgeries because of the shortcomings of levodopa and other dopaminergic agents.Surgery is the only treatment available for PD that can improve some of the parkinsonian motor features, such as bradykinesia, rigidity and tremor, and at the same time it abolishes or significantly reduces druginduced intractable dyskinesias. Thalamic DBS is preferable to thalamotomy as a means of improving function with fewer adverse effects. Bilateral thalamotomy is not recommended due to the high incidence of adverse effects. Pallidotomy or GPi-DBS, as well as subthalamotomy and STN-DBS, suppress tremor adequately and have positive effectson bradykinesia and rigidity, making them preferable to thalamotomy or thalamic DBS in PD patients. Using the STN as a surgical target has the advantage of allowing levodopa dosage reductions; however, more research is needed to confirm its safety and efficacy. Although DBS is currently preferred over ablativesurgery, there is still a role for the latter in some circumstances as explained above. Patient and family commitment and problems of availability are importantfactors in the decision to forgo DBS in favor of ablative surgery. Therefore, ablative therapy should not be totally replaced by DBS, as it may be the only or best option in some circumstances. The indication should be discussed on an individual basis with a multidisciplinary team.