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Blinded evaluation confirms long-term asymmetric effect of unilateral thalamotomy or subthalamotomy on tremor in Parkinson's disease

Department of Neurological Sciences (Drs. Diederich, Goetz, Stebbins, and Klawans), Rush Preshyterian St. Luke's Medical Center, Chicago, IL; and the Departments of General Neurosurgery (Drs. Diederich and Sanker) and Stereotactic and Functional Neurosurgery (Drs. Nittner, Koulosakis, and Sturm), University Hospitals, Cologne, Germany.

In the past, stereotactic surgery was a regular treatment for prominent unilateral tremor in Parkinson's disease (PD), but follow-up studies were usually short-term and always unblinded. We examined 17 PD patients in long-term follow-up (mean, 10.9 years after surgery) and used videotapes and the Unified Parkinson's Disease Rating Scale to blindly compare tremor ipsilateral and contralateral to the side of surgery. Since the patients were specifically selected for stereotactic surgery because of asymmetric tremor, and the surgical side chosen was contralateral to the predominant tremor, a sign of long-term efficacy would be current postoperative reversal of tremor side predominance. Upper extremity tremor was significantly better contralateral to the surgery compared with the ipsilateral side. We conclude that stereotactic surgery improved the absolute magnitude of tremor or ameliorated its rate of progression. Since asymmetric bradykinesia and dyskinesia were not a prerequisite for the choice of surgical side, we cannot make any conclusion about long-term impact of surgery on these features.

Address correspondence and reprint requests to Dr. N. Diederich, Centre Hôspitaler de Luxembourg, 4, rue Barble, L-1210, Luxembourg City, Luxembourg.

Received July 2, 1991. Accepted for publication in final form December 5, 1991.

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