Unilateral Stereotactic Radiofrequency Thalamotomy for Tremors in Parkinson’s Patients

Document Type : Original Article

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Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Parkinsonism is a clinical syndrome characterized by tremors, bradykinesia or akinesia, rigidity, and postural instability in varying proportions. Important stereotactic techniques were brought into movement disorder surgery by Spiegel and Wycis.
Aim of the work: Assessment of clinical outcomes and improvements in the quality of life after stereotactic radiofrequency thalamotomy for Idiopathic Parkinson's disease [PD] cases.
Patients and Methods: A prospective cohort study included 30 patients with idiopathic PD subjected to unilateral stereotactic radiofrequency thalamotomy. The primary outcome is the Unified PD Rating Score [UPDRS].
Results: There was a statistically significant variation in tremors among the individuals under study [p-value 0.001]. One patient [3.3%] had a grade I condition, seven [23.3%] had a grade III condition, and 22 [73.3%] had a grade IV condition. Following surgery, there were 12 cases [40%] with grade I tremors, 9 [30%] with grade II tremors, and 9 patients [30%] with no tremors at all. At 12 months Following surgery, there were 15 patients [50%] with grade I tremors, 7 [23.3%] with grade II tremors, and 8 [26.7%] with no tremors.
Conclusion: Thalamotomy can improve the tremor totally in 27% of patients [9 patients] and partially in 74% [21 patients], but it cannot stop the course of PD. For many PD patients, longer years without tremor may be possible by selectively enrolling cases, documentation of neurological impairments, localizing and creating lesion in surgery with pinpoint accuracy, and prudent after-surgery antiparkinsonian medication administration.

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