Ablative Procedures without Microelectrode Recording in the Management of Advanced Parkinson’s Disease: Complications, Safety and Outcome

Background. Lesion therapy has been used for Parkinson’s disease (PD) and other movement disorders since the early 1900s. More recently, be􀆩er understanding of the pathophysiological basis underlying the development of PD in addition to the advances in imaging technology and electrophysiological techniques used for localization of brain structures have improved the ability to accurately identify and lesion different targets deep within the brain. Objectives. The use of microelectrode recording for determining the optimal lesion location has been a subject of debate. The aim of the study is to assess the complications, safety and efficacy of the different ablative procedures without the use of microelectrode recording in the treatment of advanced Parkinson’s disease. Methods: Eighty three patients diagnosed with advanced Parkinson’s disease received ablative procedures, namely: thalamotomy and pallidotomy. Intraoperative macrostimulation was used to optimize lesion placement and to avoid injury to nearby structures. The pa􀆟ents were evaluated preopera􀆟vely and 1 month, 6 and 18 months post-operatively both clinically and using the Unified Parkinson’s Disease Rating Scale (UPDRS). Results: One hundred and five ablative procedures:-thalamotomy and pallidotomy were done without using microelectrode recording for the eighty three patients with advanced Parkinson’s disease. After pallidotomy, 36% improvement in the UPDRS off motor scores and 40% improvements in the UPDRS activities of daily living (ADL) off scores were observed, improvement after thalamotomy in the off motor and the ADL off scores were 16%, 33 % respectively, improvement was also noted in the UPDRS on motor and ADL scores, total “on” time, levodopa-induced dyskinesias, and contralateral tremor. These improvements were maintained at 18 months postoperatively. The overall incidence of complications was thus 13.4%, permanent complications being 5.8% the rest were transient with total resolution within few weeks postoperatively, hemorrhagic complications of in this series was 4.8%, visual field defects occurred in 10 % of pallidotomy patients. Conclusion: The Ablative procedures, namely thalmotomy and pallidotomy without using microelectrode recording for the Parkinson’s disease are relatively safe and effective, with only minimal and/or transient complications.