942 poster GAMMA KNIFE RADIOSURGERY (GKRS) IN THE MANAGEMENT OF PARKINSON'S DISEASE AND ESSENTIAL TREMOR: LONG-TERM FOLLOW-UP REPORT OF 196 CASES

✓ The authors report the results of a long-term follow-up study of the effects of the physiologically defined selective VIM (nucleus ventralis intermedius)-thalamotomy on tremor of Parkinson's disease in 27 patients and essential tremor in 16 patients. The follow-up period ranged from 3.25 to 10 years (mean 6.58 years). In 43 patients a total of 50 operations (including four bilateral operations and three reoperations) were carried out. The early (2 to 4 weeks after surgery) and late effects on the tremors were determined clinically and electromyographically. Fourteen parkinsonian cases were treated with minimal lesions (about 40 cu mm). Their late results were very similar to the early results: in 10, the tremors were completely abolished, three had a slight residual tremor, and one underwent reoperation 3 months after the first surgery. Eleven essential tremor cases were treated with minimal lesions. Six of these tremors were completely abolished, four patients had slight residual tremors, and one patient with a recurrence underwent reoperation 2 years after the initial surgery. In these 23 successful operations with minimal lesions (excluding two cases with reoperation), the tremor was abolished without discernible long-lasting side effects. The other 23 operations on 16 patients with Parkinson's disease (including one reoperation) and on seven with essential tremor (one of whom also had a minimal lesion on the other side) involved relatively large lesions. In this group, the surgery was successful in almost every case. It was concluded that radiographically and physiologically monitored selective VIM-thalamotomy for parkinsonian and essential tremor is effective even when lesioning is minimal. Moreover, the beneficial effect is maintained over a long period of time.

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Gamma knife thalamotomy for treatment of tremor: long-term results

Journal of Neurosurgery ◽

10.3171/jns.2000.93.supplement_3.0128 ◽

2000 ◽

Vol 93 (supplement_3) ◽

pp. 128-135 ◽

Cited By ~ 67

Author(s):

Ronald F. Young ◽

Skip Jacques ◽

Rufus Mark ◽

Oleg Kopyov ◽

Brian Copcutt ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Essential Tremor ◽

Gamma Knife ◽

Rating Scale ◽

Long Term Results ◽

Content Type ◽

Fine Print

Object. The purpose of this study was to investigate the long-term effects of gamma knife thalamotomy for treatment of disabling tremor. Methods. One hundred fifty-eight patients underwent magnetic resonance imaging—guided radiosurgical nucleus ventralis intermedius (VIM) thalamotomy for the treatment of parkinsonian tremor (102 patients), essential tremor (52 patients), or tremor due to stroke, encephalitis, or cerebral trauma (four patients). Preoperative and postoperative blinded assessments were performed by a team of independent examiners skilled in the evolution of movement disorders. A single isocenter exposure with the 4-mm collimator helmet of the Leksell gamma knife unit was used to make the lesions. In patients with Parkinson's disease 88.3% became fully or nearly tremor free, with a mean follow up of 52.5 months. Statistically significant improvements were seen in Unified Parkinson's Disease Rating Scale tremor scores and rigidity scores, and these improvements were maintained in 74 patients followed 4 years or longer. In patients with essential tremor, 92.1% were fully or nearly tremor free postoperatively, but only 88.2% remained tremor free by 4 years or more post-GKS. Statistically significant improvements were seen in the Clinical Rating Scale for tremor in essential tremor patients and these improvements were well maintained in the 17 patients, followed 4 years or longer. Only 50% of patients with tremor of other origins improved significantly. One patient sustained a transient complication and two patients sustained mild permanent side effects from the treatments. Conclusions. Gamma knife VIM thalamotomy provides relief from tremor equivalent to that provided by radiofrequency thalamotomy or deep brain stimulation, but it is safer than either of these alternatives. Long-term follow up indicates that relief of tremor is well maintained. No long-term radiation-induced complications have been observed.

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Gamma Knife Radiosurgery (GKRS) in the Management of Parkinson Disease and Essential Tremor: Long-term Follow-up Report of 183 Cases

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2009.07.307 ◽

2009 ◽

Vol 75 (3) ◽

pp. S128

Author(s):

S. Johnson ◽

H. Smith ◽

R. Mark ◽

D. Jacques ◽

R. Young ◽

...

Keyword(s):

Parkinson Disease ◽

Essential Tremor ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Long Term Follow Up

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Faculty Opinions recommendation of Long-term follow-up of a randomized AAV2-GAD gene therapy trial for Parkinson's disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727492597.793530605 ◽

2017 ◽

Author(s):

Laurent Villard

Keyword(s):

Parkinson’S Disease ◽

Gene Therapy ◽

Parkinson's Disease ◽

Gene Therapy Trial ◽

Long Term Follow Up ◽

Therapy Trial

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Long term follow-up in advanced Parkinson’s disease treated with DBS of the subthalamic nucleus

Journal of Neurology ◽

10.1007/s00415-021-10430-y ◽

2021 ◽

Author(s):

Maria Antonietta Volonté ◽

Giacomo Clarizio ◽

Sebastiano Galantucci ◽

Pietro Giuseppe Scamarcia ◽

Rosalinda Cardamone ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Subthalamic Nucleus ◽

Advanced Parkinson’S Disease ◽

Long Term Follow Up

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Gamma knife radiosurgery as a lesioning technique in movement disorder surgery

Neurosurgical FOCUS ◽

10.3171/foc.1997.2.3.14 ◽

1997 ◽

Vol 2 (3) ◽

pp. E13 ◽

Cited By ~ 4

Author(s):

Ronald F. Young ◽

Anne Shumway-Cook ◽

Sandra S. Vermeulen ◽

Peter Grimm ◽

John Blasko ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Movement Disorder ◽

Gamma Knife ◽

Movement Disorders ◽

Rating Scale ◽

Gamma Knife Radiosurgery ◽

Magnetic Resonance Images ◽

Maximum Deviation

Fifty-five patients underwent radiosurgical placement of lesions either in the thalamus (27 patients) or globus pallidus (28 patients) for treatment of movement disorders. Patients were evaluated pre- and postoperatively by a team of observers skilled in the assessment of gait and movement disorders who were blinded to the procedure performed. They were not associated with the surgical team and concomitantly and blindly also assessed a group of 11 control patients with Parkinson's disease who did not undergo any surgical procedures. All stereotactic lesions were made with the Leksell gamma unit using the 4-mm secondary collimator helmet and a single isocenter with dose maximums from 120 to 160 Gy. Clinical follow-up evaluation indicated that 88% of patients who underwent thalamotomy became tremor free or nearly tremor free. Statistically significant improvements in performance were noted in the independent assessments of Unified Parkinson's Disease Rating Scale (UPDRS) scores in the patients undergoing thalamotomy. Eighty-five and seven-tenths percent of patients undergoing pallidotomy who had exhibited levodopa-induced dyskinesias had total or near-total relief of that symptom. Clinical assessment indicated improvement of bradykinesia and rigidity in 64.3% of patients who underwent pallidotomy. Independent blinded assessments did not reveal statistically significant improvements in Hoehn and Yahr scores or UPDRS scores. On the other hand, 64.7% of patients showed improvements in subscores of the UPDRS, including activities of daily living (58%), total contralateral score (58%), and contralateral motor scores (47%). Ipsilateral total UPDRS and ipsilateral motor scores were both improved in 59% of patients. One (1.8%) of 55 patients experienced a homonymous hemianopsia 9 months after pallidotomy due to an unexpectedly large lesion. No other complications of any kind were seen. Follow-up neuroimaging confirmed correct lesion location in all patients, with a mean maximum deviation from the planned target of 1 mm in the vertical axis. Measurements of lesions at regular interals on postoperative magnetic resonance images demonstrated considerable variability in lesion volumes. The safety and efficacy of functional lesions made with the gamma knife appear to be similar to those made with the assistance of electrophysiological guidance with open functional stereotactic procedures. Functional lesions may be made safely and accurately using gamma knife radiosurgical techniques. The efficacy is equivalent to that reported for open techniques that use radiofrequency lesioning methods with electrophysiological guidance. Complications are very infrequent with the radiosurgical method. The use of functional radiosurgical lesioning to treat movement disorders is particularly attractive in older patients and those with major systemic diseases or coagulopathies; its use in the general movement disorder population seems reasonable as well.

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