Objective: A cohort of individuals diagnosed with Parkinson’s disease (PD) underwent treatment with unilateral prelemniscal radiation radiofrequency lesions (U-Raprl). This research seeks to assess prognostic indicators.

Background: Surgical interventions for PD, such as Deep Brain Stimulation (DBS) and ablative techniques, present notable benefits. While DBS, primarily focusing on the subthalamic nucleus, stands as the preferred approach, alternative methods like U-Raprl ablation exhibit potential, particularly in addressing motor symptoms [1-3].

Method: Patients previously diagnosed with PD who underwent U-Raprl were enrolled in the study, categorized into two groups based on their clinical response (< / ≥ 50%) after 5 years of follow-up using the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Factors such as age, PD progression, Hoehn and Yahr scale (HYS), and levodopa dosage were analyzed for their association with treatment response. To assess differences between groups pre- and post-intervention, a T-test was conducted, and a Mann-Whitney U test was employed to determine variations between response groups. Additionally, Cohen’s d effect size was calculated with α = 0.05 and β = 0.20.

Results: Thirty-four patients were enrolled, with tremor and rigidity being the most common symptoms. Among them, 52.9% were male, with a mean age of 59.3 ± 6.4 years and an average PD duration of 7.4 ± 2.1 years. Analysis revealed significant differences between groups (p < 0.05) concerning HYS, UPDRS, and levodopa usage after the intervention. Group analysis based on response demonstrated disparities in HYS (p < 0.01, ∆ > 1.5), Age (p < 0.0001, ∆ = 2.38), Evolution (p < 0.0001, ∆ = 2.38), and post-operative UPDRS (p < 0.01, ∆ = 1.38). Qualitative examination of responder distribution indicated that patients under 58 years of age, with less than 7 years of PD progression, and a preoperative HYS score below 2 consistently exhibited a response of ≥ 50% according to UPDRS-III in all cases (Figure 1).

Conclusion: The U-Raprl procedure demonstrates significant efficacy, maintaining improvement over a 5-year period. Key prognostic factors associated with achieving a clinical response of greater than 50% according to UPDRS-III include being under the age of 58, having a PD duration of less than 7 years, and presenting with an HYS score of 3 or lower.

Figure 1

References: [1] F.C. Velasco, P. Molina-Negro, C. Bertrand, J. Hardy. “Further definition of the subthalamic target for arrest of tremor.” J. Neurosurg. 36 (2) (1972) 184–191. https://doi.org/10.3171/jns.1972.36.2.0184.
[2] Carrillo-Ruiz J.D., Velasco F., Jiménez F., Castro G., Velasco A.L., Hernandez J.A., Ceballos J., Velasco M. “Bilateral electrical stimulation of prelemniscal radiations in the treatment of advanced Parkinson’s disease.” Neurosurgery. 2008 Feb;62(2): 347–57; discussion 357–9. https://doi.org/10.1227/01.neu.0000316001.03765.e8.
[3] M.G. García-Gomar, J. Soto-Abraham, F. Velasco-Campos, L. Concha. “Anatomic characterization of prelemniscal radiations by probabilistic tractography: implications in Parkinson’s disease.” Brain Struct. Funct. 222 (1) (2017) 71–81. https://doi.org/10.1007/s00429-016-1201-5.

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/predictive-elements-for-unilateral-prelemniscal-radiations-radiofrequency-lesions-a-novel-surgical-approach-for-alleviating-motor-symptoms-in-parkinsons-disease/