Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

A review

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  • 1 Neurosciences Research Center, Centre de Recherche du CHU de Québec;
  • 2 Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada, and
  • 3 Department of Neurosurgery and Clinical Neuroscience, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Parkinson's disease (PD) is a neurodegenerative condition that can be pharmacologically treated with levodopa. However, important motor and nonmotor symptoms appear with its long-term use. The subthalamic nucleus (STN) is known to be involved in the pathophysiology of PD and to contribute to levodopa-induced complications. Surgery is considered in patients who have advanced PD that is refractory to pharmacotherapy and who display disabling dyskinesia. Deep brain stimulation of the STN is currently the main surgical procedure for PD, but lesioning is still performed. This review covers the clinical aspects and complications of subthalamotomy as one of the lesion-based options for PD patients with levodopa-induced dyskinesias. Moreover, the authors discuss the possible effects of subthalamic lesioning.

Abbreviations used in this paper:DBS = deep brain stimulation; GAD67 = glutamic acid decarboxylase; GPe = globus pallidus externus; GPi = GP internus; LEDD = levodopa equivalency daily dose; LID = levodopa-induced dyskinesia; MPTP = 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine; NMDA = N-methyl-d-aspartate; PD = Parkinson's disease; PPN = pedunculopontine nucleus; RCT = randomized controlled trial; SNc = substantia nigra pars compacta; SNr = substantia nigra pars reticulata; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale; Zi = zona incerta; 6-OHDA = 6-hydroxydopamine.

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Contributor Notes

Address correspondence to: Thérèse Di Paolo, Ph.D., Neurosciences Research Center, Centre de Recherche du CHU de Québec, CHUL, 2705 Laurier Blvd., Quebec City, QC, Canada, G1V 4G2. email: therese.dipaolo@crchul.ulaval.ca.

Please include this information when citing this paper: published online November 8, 2013; DOI: 10.3171/2013.10.JNS13332.

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