Bilateral subthalamotomy in Parkinson's disease: initial and long-term response
Identifieur interne : 001220 ( Main/Corpus ); précédent : 001219; suivant : 001221Bilateral subthalamotomy in Parkinson's disease: initial and long-term response
Auteurs : L. Alvarez ; R. Macias ; G. Lopez ; E. Alvarez ; N. Pavon ; M. C. Rodriguez-Oroz ; J. L. Juncos ; C. Maragoto ; J. Guridi ; I. Litvan ; E. S. Tolosa ; W. Koller ; J. Vitek ; M. R. Delong ; J. A. ObesoSource :
- Brain [ 0006-8950 ] ; 2005-03.
English descriptors
- KwdEn :
- ADL = activities of daily living, CAPIT = Core Assessment Program for Intracerebral Transplantation, DBS = deep brain stimulation, FAB = Frontal Assessment Battery, GPi = globus pallidum pars interna, LID = levodopa-induced dyskinesia, MDRS = Mattis Dementia Rating Scale, MMSE = Mini-Mental Status Examination, NPI = neuropsychiatric inventory, Parkinson's disease, STN = subthalamic nucleus UPDRS = Unified Parkinson's Disease Rating Scale, WAIS = Wechsler Adult Intelligence, WCST = Wisconsin Card Sorting Test, motor complications, subthalamic nucleus, subthalamotomy, surgery.
Abstract
We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12–24 months (‘staged surgery’). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the ‘off’ (49.5%) and ‘on’ (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the ‘off’ and ‘on’ medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3–6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3–6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.
Url:
DOI: 10.1093/brain/awh397
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Juncos</name><affiliation><mods:affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Maragoto, C" sort="Maragoto, C" uniqKey="Maragoto C" first="C." last="Maragoto">C. Maragoto</name><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Guridi, J" sort="Guridi, J" uniqKey="Guridi J" first="J." last="Guridi">J. Guridi</name><affiliation><mods:affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Litvan, I" sort="Litvan, I" uniqKey="Litvan I" first="I." last="Litvan">I. Litvan</name><affiliation><mods:affiliation>Movement Disorders Program, Department of Neurology, University of Louisville School of Medicine, Louisville, KY and</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Tolosa, E S" sort="Tolosa, E S" uniqKey="Tolosa E" first="E. S." last="Tolosa">E. S. Tolosa</name><affiliation><mods:affiliation>Department of Neurology, University Hospital, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Koller, W" sort="Koller, W" uniqKey="Koller W" first="W." last="Koller">W. Koller</name><affiliation><mods:affiliation>Department of Neurology, Mount Sinai Medical School, New York, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Vitek, J" sort="Vitek, J" uniqKey="Vitek J" first="J." last="Vitek">J. Vitek</name><affiliation><mods:affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Delong, M R" sort="Delong, M R" uniqKey="Delong M" first="M. R." last="Delong">M. R. Delong</name><affiliation><mods:affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Obeso, J A" sort="Obeso, J A" uniqKey="Obeso J" first="J. A." last="Obeso">J. A. Obeso</name><affiliation><mods:affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:2A5702D5F9D6DC83FF859E37CE6870D2264D3F04</idno><date when="2005" year="2005">2005</date><idno type="doi">10.1093/brain/awh397</idno><idno type="url">https://api.istex.fr/document/2A5702D5F9D6DC83FF859E37CE6870D2264D3F04/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">001220</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Bilateral subthalamotomy in Parkinson's disease: initial and long-term response</title><author><name sortKey="Alvarez, L" sort="Alvarez, L" uniqKey="Alvarez L" first="L." last="Alvarez">L. Alvarez</name><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Macias, R" sort="Macias, R" uniqKey="Macias R" first="R." last="Macias">R. Macias</name><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Lopez, G" sort="Lopez, G" uniqKey="Lopez G" first="G." last="Lopez">G. Lopez</name><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Alvarez, E" sort="Alvarez, E" uniqKey="Alvarez E" first="E." last="Alvarez">E. Alvarez</name><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Pavon, N" sort="Pavon, N" uniqKey="Pavon N" first="N." last="Pavon">N. Pavon</name><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Rodriguez Oroz, M C" sort="Rodriguez Oroz, M C" uniqKey="Rodriguez Oroz M" first="M. C." last="Rodriguez-Oroz">M. C. Rodriguez-Oroz</name><affiliation><mods:affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Juncos, J L" sort="Juncos, J L" uniqKey="Juncos J" first="J. L." last="Juncos">J. L. Juncos</name><affiliation><mods:affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Maragoto, C" sort="Maragoto, C" uniqKey="Maragoto C" first="C." last="Maragoto">C. Maragoto</name><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Guridi, J" sort="Guridi, J" uniqKey="Guridi J" first="J." last="Guridi">J. Guridi</name><affiliation><mods:affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Litvan, I" sort="Litvan, I" uniqKey="Litvan I" first="I." last="Litvan">I. Litvan</name><affiliation><mods:affiliation>Movement Disorders Program, Department of Neurology, University of Louisville School of Medicine, Louisville, KY and</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Tolosa, E S" sort="Tolosa, E S" uniqKey="Tolosa E" first="E. S." last="Tolosa">E. S. Tolosa</name><affiliation><mods:affiliation>Department of Neurology, University Hospital, Barcelona, Spain,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Koller, W" sort="Koller, W" uniqKey="Koller W" first="W." last="Koller">W. Koller</name><affiliation><mods:affiliation>Department of Neurology, Mount Sinai Medical School, New York, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Vitek, J" sort="Vitek, J" uniqKey="Vitek J" first="J." last="Vitek">J. Vitek</name><affiliation><mods:affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Delong, M R" sort="Delong, M R" uniqKey="Delong M" first="M. R." last="Delong">M. R. Delong</name><affiliation><mods:affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author><author><name sortKey="Obeso, J A" sort="Obeso, J A" uniqKey="Obeso J" first="J. A." last="Obeso">J. A. Obeso</name><affiliation><mods:affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</mods:affiliation></affiliation><affiliation><mods:affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Brain</title><title level="j" type="abbrev">Brain</title><idno type="ISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2005-03">2005-03</date><biblScope unit="volume">128</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="570">570</biblScope><biblScope unit="page" to="583">583</biblScope></imprint><idno type="ISSN">0006-8950</idno></series><idno type="istex">2A5702D5F9D6DC83FF859E37CE6870D2264D3F04</idno><idno type="DOI">10.1093/brain/awh397</idno><idno type="local">awh397</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ADL = activities of daily living</term><term>CAPIT = Core Assessment Program for Intracerebral Transplantation</term><term>DBS = deep brain stimulation</term><term>FAB = Frontal Assessment Battery</term><term>GPi = globus pallidum pars interna</term><term>LID = levodopa-induced dyskinesia</term><term>MDRS = Mattis Dementia Rating Scale</term><term>MMSE = Mini-Mental Status Examination</term><term>NPI = neuropsychiatric inventory</term><term>Parkinson's disease</term><term>STN = subthalamic nucleus UPDRS = Unified Parkinson's Disease Rating Scale</term><term>WAIS = Wechsler Adult Intelligence</term><term>WCST = Wisconsin Card Sorting Test</term><term>motor complications</term><term>subthalamic nucleus</term><term>subthalamotomy</term><term>surgery</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12–24 months (‘staged surgery’). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the ‘off’ (49.5%) and ‘on’ (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the ‘off’ and ‘on’ medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3–6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3–6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>L. Alvarez</name><affiliations><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>R. Macias</name><affiliations><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>G. Lopez</name><affiliations><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>E. Alvarez</name><affiliations><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>N. Pavon</name><affiliations><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>M. C. Rodriguez-Oroz</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>J. L. Juncos</name><affiliations><json:string>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>C. Maragoto</name><affiliations><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>J. Guridi</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>I. Litvan</name><affiliations><json:string>Movement Disorders Program, Department of Neurology, University of Louisville School of Medicine, Louisville, KY and</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>E. S. Tolosa</name><affiliations><json:string>Department of Neurology, University Hospital, Barcelona, Spain,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>W. Koller</name><affiliations><json:string>Department of Neurology, Mount Sinai Medical School, New York, USA</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>J. Vitek</name><affiliations><json:string>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>M. R. DeLong</name><affiliations><json:string>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item><json:item><name>J. A. Obeso</name><affiliations><json:string>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</json:string><json:string>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Articles</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>motor complications</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>surgery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subthalamotomy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ADL = activities of daily living</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>CAPIT = Core Assessment Program for Intracerebral Transplantation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>DBS = deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>FAB = Frontal Assessment Battery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>GPi = globus pallidum pars interna</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>LID = levodopa-induced dyskinesia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>MMSE = Mini-Mental Status Examination</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>MDRS = Mattis Dementia Rating Scale</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>NPI = neuropsychiatric inventory</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>STN = subthalamic nucleus UPDRS = Unified Parkinson's Disease Rating Scale</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>WAIS = Wechsler Adult Intelligence</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>WCST = Wisconsin Card Sorting Test</value></json:item></subject><language><json:string>eng</json:string></language><abstract>We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12–24 months (‘staged surgery’). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P > 0.001) reduction in the ‘off’ (49.5%) and ‘on’ (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the ‘off’ and ‘on’ medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P > 0.01). Levodopa-induced dyskinesias were reduced by 50% (P > 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P > 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3–6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3–6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.</abstract><qualityIndicators><score>8.5</score><pdfVersion>1.4</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>18</keywordCount><abstractCharCount>2291</abstractCharCount><pdfWordCount>10596</pdfWordCount><pdfCharCount>66607</pdfCharCount><pdfPageCount>14</pdfPageCount><abstractWordCount>335</abstractWordCount></qualityIndicators><title>Bilateral subthalamotomy in Parkinson's disease: initial and long-term response</title><genre><json:string>research-article</json:string></genre><host><volume>128</volume><pages><last>583</last><first>570</first></pages><issn><json:string>0006-8950</json:string></issn><issue>3</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1460-2156</json:string></eissn><title>Brain</title></host><categories><wos><json:string>CLINICAL NEUROLOGY</json:string><json:string>NEUROSCIENCES</json:string></wos></categories><publicationDate>2005</publicationDate><copyrightDate>2005</copyrightDate><doi><json:string>10.1093/brain/awh397</json:string></doi><id>2A5702D5F9D6DC83FF859E37CE6870D2264D3F04</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/2A5702D5F9D6DC83FF859E37CE6870D2264D3F04/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/2A5702D5F9D6DC83FF859E37CE6870D2264D3F04/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/2A5702D5F9D6DC83FF859E37CE6870D2264D3F04/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Bilateral subthalamotomy in Parkinson's disease: initial and long-term response</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>OUP</p></availability><date>2005-02-02</date></publicationStmt><notesStmt><note>Correspondence to: Jose A. Obeso, Neurologia-Neurociencias, Clinica Universitaria, Avenida Pio XII, 36, Pamplona 31008, Spain E-mail: jobeso@unav.es</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Bilateral subthalamotomy in Parkinson's disease: initial and long-term response</title><author><persName><forename type="first">L.</forename><surname>Alvarez</surname></persName><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">R.</forename><surname>Macias</surname></persName><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">G.</forename><surname>Lopez</surname></persName><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">E.</forename><surname>Alvarez</surname></persName><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">N.</forename><surname>Pavon</surname></persName><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">M. C.</forename><surname>Rodriguez-Oroz</surname></persName><affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">J. L.</forename><surname>Juncos</surname></persName><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">C.</forename><surname>Maragoto</surname></persName><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">J.</forename><surname>Guridi</surname></persName><affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">I.</forename><surname>Litvan</surname></persName><affiliation>Movement Disorders Program, Department of Neurology, University of Louisville School of Medicine, Louisville, KY and</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">E. S.</forename><surname>Tolosa</surname></persName><affiliation>Department of Neurology, University Hospital, Barcelona, Spain,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">W.</forename><surname>Koller</surname></persName><affiliation>Department of Neurology, Mount Sinai Medical School, New York, USA</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">J.</forename><surname>Vitek</surname></persName><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">M. R.</forename><surname>DeLong</surname></persName><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author><author><persName><forename type="first">J. A.</forename><surname>Obeso</surname></persName><affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation></author></analytic><monogr><title level="j">Brain</title><title level="j" type="abbrev">Brain</title><idno type="pISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2005-03"></date><biblScope unit="volume">128</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="570">570</biblScope><biblScope unit="page" to="583">583</biblScope></imprint></monogr><idno type="istex">2A5702D5F9D6DC83FF859E37CE6870D2264D3F04</idno><idno type="DOI">10.1093/brain/awh397</idno><idno type="local">awh397</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2005-02-02</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12–24 months (‘staged surgery’). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the ‘off’ (49.5%) and ‘on’ (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the ‘off’ and ‘on’ medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3–6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3–6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>subthalamic nucleus</term></item><item><term>Parkinson's disease</term></item><item><term>motor complications</term></item><item><term>surgery</term></item><item><term>subthalamotomy</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>ABR</head><item><term>ADL = activities of daily living</term></item><item><term>CAPIT = Core Assessment Program for Intracerebral Transplantation</term></item><item><term>DBS = deep brain stimulation</term></item><item><term>FAB = Frontal Assessment Battery</term></item><item><term>GPi = globus pallidum pars interna</term></item><item><term>LID = levodopa-induced dyskinesia</term></item><item><term>MMSE = Mini-Mental Status Examination</term></item><item><term>MDRS = Mattis Dementia Rating Scale</term></item><item><term>NPI = neuropsychiatric inventory</term></item><item><term>STN = subthalamic nucleus UPDRS = Unified Parkinson's Disease Rating Scale</term></item><item><term>WAIS = Wechsler Adult Intelligence</term></item><item><term>WCST = Wisconsin Card Sorting Test</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2005-02-02">Created</change><change when="2005-03">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/2A5702D5F9D6DC83FF859E37CE6870D2264D3F04/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="US-ASCII"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">brain</journal-id><journal-id journal-id-type="nlm-ta">Brain</journal-id><journal-id journal-id-type="publisher-id">brainj</journal-id><journal-title>Brain</journal-title><abbrev-journal-title abbrev-type="publisher">Brain</abbrev-journal-title><issn pub-type="ppub">0006-8950</issn><issn pub-type="epub">1460-2156</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">awh397</article-id><article-id pub-id-type="doi">10.1093/brain/awh397</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Bilateral subthalamotomy in Parkinson's disease: initial and long-term response</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Alvarez</surname><given-names>L.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Macias</surname><given-names>R.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lopez</surname><given-names>G.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Alvarez</surname><given-names>E.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Pavon</surname><given-names>N.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Rodriguez-Oroz</surname><given-names>M. C.</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Juncos</surname><given-names>J. L.</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Maragoto</surname><given-names>C.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Guridi</surname><given-names>J.</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Litvan</surname><given-names>I.</given-names></name><xref rid="AFF5">5</xref></contrib><contrib contrib-type="author"><name><surname>Tolosa</surname><given-names>E. S.</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author"><name><surname>Koller</surname><given-names>W.</given-names></name><xref rid="AFF6">6</xref></contrib><contrib contrib-type="author"><name><surname>Vitek</surname><given-names>J.</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>DeLong</surname><given-names>M. R.</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Obeso</surname><given-names>J. A.</given-names></name><xref rid="AFF2">2</xref></contrib><aff><target target-type="aff" id="AFF1"></target><label>1</label>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba, <target target-type="aff" id="AFF2"></target><label>2</label>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona, <target target-type="aff" id="AFF3"></target><label>3</label>Department of Neurology, University Hospital, Barcelona, Spain, <target target-type="aff" id="AFF4"></target><label>4</label>Department of Neurology, Emory University School of Medicine, Atlanta, GA, <target target-type="aff" id="AFF5"></target><label>5</label>Movement Disorders Program, Department of Neurology, University of Louisville School of Medicine, Louisville, KY and <target target-type="aff" id="AFF6"></target><label>6</label>Department of Neurology, Mount Sinai Medical School, New York, USA</aff></contrib-group><author-notes><corresp>Correspondence to: Jose A. Obeso, Neurologia-Neurociencias, Clinica Universitaria, Avenida Pio XII, 36, Pamplona 31008, Spain E-mail: <ext-link xlink:href="jobeso@unav.es" ext-link-type="email">jobeso@unav.es</ext-link></corresp></author-notes><pub-date pub-type="epub"><day>2</day><month>2</month><year>2005</year></pub-date><pub-date pub-type="ppub"><month>3</month><year>2005</year></pub-date><volume>128</volume><issue>3</issue><fpage>570</fpage><lpage>583</lpage><history><date date-type="accepted"><day>17</day><month>12</month><year>2004</year></date><date date-type="received"><day>19</day><month>5</month><year>2004</year></date><date date-type="rev-recd"><day>7</day><month>11</month><year>2004</year></date></history><copyright-statement>© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please e-mail: <ext-link xlink:href="journal.permissions@oupjournals.org" ext-link-type="email">journal.permissions@oupjournals.org</ext-link></copyright-statement><copyright-year>2005</copyright-year><abstract xml:lang="en"><p>We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12–24 months (‘staged surgery’). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (<italic>P</italic> < 0.001) reduction in the ‘off’ (49.5%) and ‘on’ (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the ‘off’ and ‘on’ medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (<italic>P</italic> < 0.01). Levodopa-induced dyskinesias were reduced by 50% (<italic>P</italic> < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (<italic>P</italic> < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3–6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3–6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.</p></abstract><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>subthalamic nucleus</kwd><kwd>Parkinson's disease</kwd><kwd>motor complications</kwd><kwd>surgery</kwd><kwd>subthalamotomy</kwd></kwd-group><kwd-group kwd-group-type="ABR" xml:lang="en"><kwd>ADL = activities of daily living</kwd><kwd>CAPIT = Core Assessment Program for Intracerebral Transplantation</kwd><kwd>DBS = deep brain stimulation</kwd><kwd>FAB = Frontal Assessment Battery</kwd><kwd>GPi = globus pallidum pars interna</kwd><kwd>LID = levodopa-induced dyskinesia</kwd><kwd>MMSE = Mini-Mental Status Examination</kwd><kwd>MDRS = Mattis Dementia Rating Scale</kwd><kwd>NPI = neuropsychiatric inventory</kwd><kwd>STN = subthalamic nucleus UPDRS = Unified Parkinson's Disease Rating Scale</kwd><kwd>WAIS = Wechsler Adult Intelligence</kwd><kwd>WCST = Wisconsin Card Sorting Test</kwd></kwd-group><custom-meta-wrap><custom-meta><meta-name>hwp-legacy-fpage</meta-name><meta-value>570</meta-value></custom-meta><custom-meta><meta-name>hwp-legacy-dochead</meta-name><meta-value>Article</meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Bilateral subthalamotomy in Parkinson's disease: initial and long-term response</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Bilateral subthalamotomy in Parkinson's disease: initial and long-term response</title></titleInfo><name type="personal"><namePart type="given">L.</namePart><namePart type="family">Alvarez</namePart><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R.</namePart><namePart type="family">Macias</namePart><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G.</namePart><namePart type="family">Lopez</namePart><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E.</namePart><namePart type="family">Alvarez</namePart><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">N.</namePart><namePart type="family">Pavon</namePart><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M. C.</namePart><namePart type="family">Rodriguez-Oroz</namePart><affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J. L.</namePart><namePart type="family">Juncos</namePart><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C.</namePart><namePart type="family">Maragoto</namePart><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Guridi</namePart><affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">I.</namePart><namePart type="family">Litvan</namePart><affiliation>Movement Disorders Program, Department of Neurology, University of Louisville School of Medicine, Louisville, KY and</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E. S.</namePart><namePart type="family">Tolosa</namePart><affiliation>Department of Neurology, University Hospital, Barcelona, Spain,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">W.</namePart><namePart type="family">Koller</namePart><affiliation>Department of Neurology, Mount Sinai Medical School, New York, USA</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.</namePart><namePart type="family">Vitek</namePart><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M. R.</namePart><namePart type="family">DeLong</namePart><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, GA,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J. A.</namePart><namePart type="family">Obeso</namePart><affiliation>Departments of Neurology and Neurosurgery, Neuroscience Center, Clinica Universitaria and Medical School, University of Navarra and FIMA, Pamplona,</affiliation><affiliation>Movement Disorders and Neurophysiology Units, Centro Internacional de Restauracion Neurologica (CIREN), La Habana, Cuba,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2005-03</dateIssued><dateCreated encoding="w3cdtf">2005-02-02</dateCreated><copyrightDate encoding="w3cdtf">2005</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12–24 months (‘staged surgery’). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the ‘off’ and ‘on’ drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the ‘off’ (49.5%) and ‘on’ (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the ‘off’ and ‘on’ medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3–6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3–6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.</abstract><note type="author-notes">Correspondence to: Jose A. Obeso, Neurologia-Neurociencias, Clinica Universitaria, Avenida Pio XII, 36, Pamplona 31008, Spain E-mail: jobeso@unav.es</note><subject lang="en"><genre>KWD</genre><topic>subthalamic nucleus</topic><topic>Parkinson's disease</topic><topic>motor complications</topic><topic>surgery</topic><topic>subthalamotomy</topic></subject><subject lang="en"><genre>ABR</genre><topic>ADL = activities of daily living</topic><topic>CAPIT = Core Assessment Program for Intracerebral Transplantation</topic><topic>DBS = deep brain stimulation</topic><topic>FAB = Frontal Assessment Battery</topic><topic>GPi = globus pallidum pars interna</topic><topic>LID = levodopa-induced dyskinesia</topic><topic>MMSE = Mini-Mental Status Examination</topic><topic>MDRS = Mattis Dementia Rating Scale</topic><topic>NPI = neuropsychiatric inventory</topic><topic>STN = subthalamic nucleus UPDRS = Unified Parkinson's Disease Rating Scale</topic><topic>WAIS = Wechsler Adult Intelligence</topic><topic>WCST = Wisconsin Card Sorting Test</topic></subject><relatedItem type="host"><titleInfo><title>Brain</title></titleInfo><titleInfo type="abbreviated"><title>Brain</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0006-8950</identifier><identifier type="eISSN">1460-2156</identifier><identifier type="PublisherID">brainj</identifier><identifier type="PublisherID-hwp">brain</identifier><identifier type="PublisherID-nlm-ta">Brain</identifier><part><date>2005</date><detail type="volume"><caption>vol.</caption><number>128</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>570</start><end>583</end></extent></part></relatedItem><identifier type="istex">2A5702D5F9D6DC83FF859E37CE6870D2264D3F04</identifier><identifier type="DOI">10.1093/brain/awh397</identifier><identifier type="local">awh397</identifier><accessCondition type="use and reproduction" contentType="copyright">© The Author (2005). 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