Bilateral subthalamic deep brain stimulation in a patient with Parkinson's disease who had previously undergone thalamotomy and autologous adrenal grafting in the caudate nucleus

Case report

Francesco Vergani, Andrea Landi, Angelo Antonini, Erik P. Sganzerla

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVE: Subthalamic (Stn) deep brain stimulation (DBS) is a valid surgical therapy for the treatment of severe Parkinson's disease. In recent years, StnDBS has been proposed for patients who previously received other surgical treatments, such as thalamotomy and pallidotomy. Nonetheless, there is no consensus about the indications of DBS in patients who previously underwent surgery. To the best of our knowledge this is the first reported case of a patient treated with DBS after previous thalamotomy and adrenal grafting. CLINICAL PRESENTATION: A 62-year-old man with a long history (more than 30 yr) of Parkinson's disease received unilateral thalamotomy and autologous adrenal graft on two independent occasions. Thalamotomy led to a significant improvement, although limited to the control of contralateral tremor. The autologous adrenal graft was of no benefit. For the subsequent occurrence of L-dopa related dyskinesias and severe "off" periods, the patient was referred to our center for StnDBS. INTERVENTION: The patient underwent bilateral StnDBS, obtaining a satisfactory improvement of rigidity and bradykinesia on both sides. The 1-year follow-up evaluation showed a 46% improvement in the Unified Parkinson's Disease Rating Scale motor section, along with a noticeable reduction in antiparkinsonian therapy (81%). CONCLUSION: This case is consistent with previous reports from the literature, suggesting that StnDBS is feasible and safe, even in patients who previously received other surgical treatments for Parkinson's disease, such as thalamotomy or cell grafting.

Original languageEnglish
Pages (from-to)1146-1149
Number of pages4
JournalNeurosurgery
Volume59
Issue number5
DOIs
Publication statusPublished - Nov 2006

Fingerprint

Deep Brain Stimulation
Caudate Nucleus
Parkinson Disease
Pallidotomy
Antiparkinson Agents
Transplants
Therapeutics
Hypokinesia
Dyskinesias
Levodopa
Tremor
History

Keywords

  • Adrenal grafting
  • Parkinson's disease
  • Subthalamic deep brain stimulation
  • Thalamotomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Bilateral subthalamic deep brain stimulation in a patient with Parkinson's disease who had previously undergone thalamotomy and autologous adrenal grafting in the caudate nucleus : Case report. / Vergani, Francesco; Landi, Andrea; Antonini, Angelo; Sganzerla, Erik P.

In: Neurosurgery, Vol. 59, No. 5, 11.2006, p. 1146-1149.

Research output: Contribution to journalArticle

@article{077a45aa18e8403689e3568a90c29a76,
title = "Bilateral subthalamic deep brain stimulation in a patient with Parkinson's disease who had previously undergone thalamotomy and autologous adrenal grafting in the caudate nucleus: Case report",
abstract = "OBJECTIVE: Subthalamic (Stn) deep brain stimulation (DBS) is a valid surgical therapy for the treatment of severe Parkinson's disease. In recent years, StnDBS has been proposed for patients who previously received other surgical treatments, such as thalamotomy and pallidotomy. Nonetheless, there is no consensus about the indications of DBS in patients who previously underwent surgery. To the best of our knowledge this is the first reported case of a patient treated with DBS after previous thalamotomy and adrenal grafting. CLINICAL PRESENTATION: A 62-year-old man with a long history (more than 30 yr) of Parkinson's disease received unilateral thalamotomy and autologous adrenal graft on two independent occasions. Thalamotomy led to a significant improvement, although limited to the control of contralateral tremor. The autologous adrenal graft was of no benefit. For the subsequent occurrence of L-dopa related dyskinesias and severe {"}off{"} periods, the patient was referred to our center for StnDBS. INTERVENTION: The patient underwent bilateral StnDBS, obtaining a satisfactory improvement of rigidity and bradykinesia on both sides. The 1-year follow-up evaluation showed a 46{\%} improvement in the Unified Parkinson's Disease Rating Scale motor section, along with a noticeable reduction in antiparkinsonian therapy (81{\%}). CONCLUSION: This case is consistent with previous reports from the literature, suggesting that StnDBS is feasible and safe, even in patients who previously received other surgical treatments for Parkinson's disease, such as thalamotomy or cell grafting.",
keywords = "Adrenal grafting, Parkinson's disease, Subthalamic deep brain stimulation, Thalamotomy",
author = "Francesco Vergani and Andrea Landi and Angelo Antonini and Sganzerla, {Erik P.}",
year = "2006",
month = "11",
doi = "10.1227/01.NEU.0000245585.93284.15",
language = "English",
volume = "59",
pages = "1146--1149",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Bilateral subthalamic deep brain stimulation in a patient with Parkinson's disease who had previously undergone thalamotomy and autologous adrenal grafting in the caudate nucleus

T2 - Case report

AU - Vergani, Francesco

AU - Landi, Andrea

AU - Antonini, Angelo

AU - Sganzerla, Erik P.

PY - 2006/11

Y1 - 2006/11

N2 - OBJECTIVE: Subthalamic (Stn) deep brain stimulation (DBS) is a valid surgical therapy for the treatment of severe Parkinson's disease. In recent years, StnDBS has been proposed for patients who previously received other surgical treatments, such as thalamotomy and pallidotomy. Nonetheless, there is no consensus about the indications of DBS in patients who previously underwent surgery. To the best of our knowledge this is the first reported case of a patient treated with DBS after previous thalamotomy and adrenal grafting. CLINICAL PRESENTATION: A 62-year-old man with a long history (more than 30 yr) of Parkinson's disease received unilateral thalamotomy and autologous adrenal graft on two independent occasions. Thalamotomy led to a significant improvement, although limited to the control of contralateral tremor. The autologous adrenal graft was of no benefit. For the subsequent occurrence of L-dopa related dyskinesias and severe "off" periods, the patient was referred to our center for StnDBS. INTERVENTION: The patient underwent bilateral StnDBS, obtaining a satisfactory improvement of rigidity and bradykinesia on both sides. The 1-year follow-up evaluation showed a 46% improvement in the Unified Parkinson's Disease Rating Scale motor section, along with a noticeable reduction in antiparkinsonian therapy (81%). CONCLUSION: This case is consistent with previous reports from the literature, suggesting that StnDBS is feasible and safe, even in patients who previously received other surgical treatments for Parkinson's disease, such as thalamotomy or cell grafting.

AB - OBJECTIVE: Subthalamic (Stn) deep brain stimulation (DBS) is a valid surgical therapy for the treatment of severe Parkinson's disease. In recent years, StnDBS has been proposed for patients who previously received other surgical treatments, such as thalamotomy and pallidotomy. Nonetheless, there is no consensus about the indications of DBS in patients who previously underwent surgery. To the best of our knowledge this is the first reported case of a patient treated with DBS after previous thalamotomy and adrenal grafting. CLINICAL PRESENTATION: A 62-year-old man with a long history (more than 30 yr) of Parkinson's disease received unilateral thalamotomy and autologous adrenal graft on two independent occasions. Thalamotomy led to a significant improvement, although limited to the control of contralateral tremor. The autologous adrenal graft was of no benefit. For the subsequent occurrence of L-dopa related dyskinesias and severe "off" periods, the patient was referred to our center for StnDBS. INTERVENTION: The patient underwent bilateral StnDBS, obtaining a satisfactory improvement of rigidity and bradykinesia on both sides. The 1-year follow-up evaluation showed a 46% improvement in the Unified Parkinson's Disease Rating Scale motor section, along with a noticeable reduction in antiparkinsonian therapy (81%). CONCLUSION: This case is consistent with previous reports from the literature, suggesting that StnDBS is feasible and safe, even in patients who previously received other surgical treatments for Parkinson's disease, such as thalamotomy or cell grafting.

KW - Adrenal grafting

KW - Parkinson's disease

KW - Subthalamic deep brain stimulation

KW - Thalamotomy

UR - http://www.scopus.com/inward/record.url?scp=33845223664&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33845223664&partnerID=8YFLogxK

U2 - 10.1227/01.NEU.0000245585.93284.15

DO - 10.1227/01.NEU.0000245585.93284.15

M3 - Article

VL - 59

SP - 1146

EP - 1149

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 5

ER -