CT-guided unilateral thalamotomy with macroelectrode mapping for the treatment of Parkinson's disease.

ABSTRACT

OBJECTIVE: To evaluate the effect of unilateral thalamotomy in patients with Parkinson's disease. METHODS: The junction of the ventralis oralis posterior and ventralis intermedius nuclei targeted under CT-guidance, and confirmed by impedance recording and macrostimulation. RESULTS: At the 6-month assessment the tremor has been completely abolished in 37 patients (82.2%), and reduced in 6 patients (13.3%). The Unified Parkinson's Disease Rating Scale tremor score decreased by 92.5%, rigidity improved by 65.9%. Axial symptoms and bradykinesia showed smaller improvement. The levodopa and anti-cholinergic medication significantly reduced. An improvement in the quality of life measured by the Parkinson's Disease Questionnaire (PDQ-39) has been observed. The dimensions of mobility, activities of daily living, emotional well being, and stigma were significantly (P<0.05) better, other changes were not significant. The single index improved from 47.8+/-7.8 to 28.9+/-6.3. Transient complications noted in 9 patients (20%), mild persistent morbidity observed in 3 patients (6.7%). At the 1, 2 and 3-year follow-up neither contralateral tremor, rigidity, nor bradykinesia progression was statistically significant. CONCLUSIONS: CT-guided thalamotomy with macro-electrode mapping provides a safe, effective and long lasting control of tremor and rigidity, reduces the need for medication, and improves the quality of life.