Pallidothalamic tractotomy [Neurosurgery Wiki]

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====== Pallidothalamic tractotomy ======

[[Pallidothalamic tractotomy for cervical dystonia]].


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A limited number of studies have reported the [[effect]] of [[ablation]] of the [[pallidothalamic tracts]] for [[Parkinson's disease]]. 

Horisawa et al. evaluated the [[safety]] and [[efficacy]] of unilateral pallidothalamic [[tractotomy]] for [[akinetic-rigid Parkinson's disease]].

Fourteen [[akinetic-rigid Parkinson's disease]] patients, who were enrolled in this prospective open-label study, underwent unilateral [[pallidothalamic tractotomy]]. The [[Movement Disorder Society]]-Unified Parkinson's Disease Rating Scale (MDS-[[UPDRS]]) Part III and Part IV ([[dyskinesia]] and [[dystonia]]) scores and [[levodopa equivalent daily dose]] (LEDD) were evaluated at [[baseline]] and at 3 and 12 months postoperatively.

Of the 14 patients enrolled in the study, 4 were lost to follow-up and 10 were analyzed. The total MDS-UPDRS Part III score significantly improved from 45 ± 4.6 at baseline to 32.9 ± 4.8 at 12 months postoperatively (p = 0.005). Contralateral side rigidity and bradykinesia significantly improved from 4.4 ± 0.5 and 10.4 ± 1.5 at baseline to 1.7 ± 0.4 (p = 0.005) and 5.2 ± 1.4 (p = 0.011) at 12 months, respectively. While [[posture]] significantly improved with a 20% reduction in scores (p = 0.038), no significant improvement was found in [[gait]] (p = 0.066). [[Dyskinesia]] and [[dystonia]] were improved with a 79.2% (p = 0.0012) and 91.7% (p = 0.041) reduction in scores, respectively. No significant change was found in the LEDD. [[Hypophonia]] was noted in 2 patients, eyelid [[apraxia]] was noted in 1 patient, and a reduced response to [[levodopa]], which resulted in an increase in the daily dose of levodopa, was noted in 3 patients. No serious permanent [[neurological deficit]]s were observed.

Unilateral pallidothalamic tractotomy improved contralateral side rigidity and [[bradykinesia]], [[dyskinesia]], and [[dystonia]] in patients with [[akinetic-rigid Parkinson's disease]].[[Clinical trial]] registration no.: UMIN000031138 (umin.ac.jp)
((Horisawa S, Fukui A, Yamahata H, Tanaka Y, Kuwano A, Momosaki O, Iijima M, Nanke M, Kawamata T, Taira T. Unilateral pallidothalamic tractotomy for akinetic-rigid Parkinson's disease: a prospective open-label study. J Neurosurg. 2021 Jan 15:1-7. doi: 10.3171/2020.7.JNS201547. Epub ahead of print. PMID: 33450738.)).