ABSTRACT
Surgery for Parkinson’s disease (PD) was revitalized some 10 years ago when pallidotomy was shown to improve the cardinal features on the side contralateral to the lesion and drastically reduce levodopa-induced dyskinesias (1). Axial motor features such as gait initiation and freezing problems, flexor posture of the trunk, and postural reflexes do not respond to pallidotomy (2,3). Bilateral pallidotomy is associated with a large incidence of cognitive and speech problems, and consequently this surgical procedure is rarely performed (4-6). Deep brain stimulation (DBS) of the globus pallidus internus (GPi) and subthalamic nucleus (STN) may be performed bilaterally without a similar rate and severity of complications and are the current therapies for surgical treatment of advanced PD. However, DBS is an expensive technique and, therefore, is not available worldwide. Subthalamotomy could be an alternative for specific patients under special circumstances.
