Bilateral Stereotaxic Lesions in the Management of Parkinsonism and the Dyskinesias

Abstract

Seventy-five patients with Parkinsonism and eight with dyskinesias were treated with bilateral stereotaxic operations by the method of Guiot modified by Gillingham. The sites of lesions in the thalamus, capsule, and pallidum were verified by radiology and stereotaxic atlas charting and in some cases by biopsy, depth electrical recording, and necropsy. Immediate post-operative mortality was nil. Major postoperative complications involving motor, sensory, or visual systems did not occur. Speech disturbances were the main disadvantages of bilateral procedures. Whenever there was slurring of speech or diminution of voice volume after the first procedure these defects tended to become worse after the second. Rigidity and tremor were particularly amenable to surgery. Oculogyric crises were benefited in a large proportion of patients. Other symptoms were improved to a varying degree. Immediate assessment showed satisfactory improvement in 70 out of 75 cases. Long-term follow-up showed maintenance of improvement in 55 out of 66 cases. From this study the main indications for bilateral surgery would appear to be advancing signs and symptoms in the contralateral limbs and persistence of oculogyric crises, especially when the first operation had been successful. The main contraindications would seem to be definite deterioration of speech or intellectual and psychological status after the first operation. © 1964, British Medical Journal Publishing Group. All rights reserved.