Session Time: 1:45pm-3:15pm
Location: Exhibit Hall C
Objective: To assess the feasibility of GammaKnife subthalamotomy in Parkinson’s disease
Background: Chronic STN stimulation is an established treatment for complicated PD. Bilateral subthalamotomy may induce significant and long-lasting results when DBS is not available. However, which alternative can be proposed for patients with surgical contraindications for electrodes implantation? GammaKnife (GK) thalamotomy is an effective therapy for treating disabling tremor. This technique encounters very few contraindications. We report the results of a prospective trial on GK Subthalamotomy for patients with absolute contraindications for DBS. The primary endpoint was tolerance.
Methods: 14 PD patients (10men, mean age 66.4) with severe motor complications were included. STN DBS was contraindicated because of vasculopathy or anticoagulant treatment. Patients were assessed before and quarterly for at least 24 months after GK subthalmotomy. A unilateral GK subthalamotomy on the most affected side was proposed first followed by contralateral subthalamotomy after M12 if necessary. STN lesioning was performed with Leksell Gamma unit with a single exposure through a 4mm collimator. Radiosurgical dose was 110Grays.
Results: 12 patients were assessed at 2 years. 2 patients died before M6 (stroke, suicide). 7 patients had bilateral GK subthalamotomy, 5 unilateral (2 previous contralateral STN DBS, 2 refusals, 1 unilateral disease). UPDRS motor score was improved by 17.6% at M24, motor fluctuations by 18% and dyskinesia were reduced by 66%. Cognitive score was stable except for one patient. No significant decrease in LEDD was observed. MRI STN lesion appeared 9 months after radiosurgery. One patient was an hyporesponder and 4 had an hyperresponse with clinical consequences: Severe transient dyskinesia (2), transient hemiparesia and delirium (1), permanent hemiplegia.
Conclusions: Apart from a significant decrease in dyskinesias, the patients did not improve following STN GK and several experienced adverse effects.Although the cohort is small and with high comorbidities, this study does not indicate that GK subthalamotomy may be a good alternative to DBS for advanced PD.
To cite this abstract in AMA style:t. witjas, r. carron, a. eusebio, j.p. azulay, j. regis. GammaKnife subthalamotomy for Parkinson’s disease [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/gammaknife-subthalamotomy-for-parkinsons-disease/. Accessed December 2, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/gammaknife-subthalamotomy-for-parkinsons-disease/