Comparison of Stereotactic Subthalamotomy and Ventralis Intermedius (VIM) Thalamotomy in Relieving Parkinsonian Tremor

Abstract

Background/Objectives: Parkinson’s disease is a neurodegenerative disease with cardinal features of tremor, rigidity, postural instability and bradykinesia. Surgery is indicated for the patients not responding to medical management or who develop motor fluctuations and dyskinesia following prolonged levodopa therapy. Stereotactic Subthalamotomy and VIM (Ventralis Intermedius) Thalamotomy is cheap, safe and effective surgical options for the treatment of Parkinsonian tremor. The objective of the study was to compare Stereotactic Subthalamotomy with Ventralis Intermedius (VIM) Thalamotomy, in terms of improvement in Unified Parkinson’s Disease Rating Scale (UPDRS), for the treatment of Parkinsonian tremor.
 Material and Methods: This is a randomized control trial (RCT) and 38 tremor predominant Parkinsonian patients were enrolled in the study. Half of the patients underwent Stereotactic Subthalamotomy and another half underwent VIM Thalamotomy. Patients were assessed pre-operatively, immediately post-operatively and followed up at three weeks, six weeks and three months by using UPDRS scores.
 Results: The mean age of patients was 59.58 years and they were predominantly male. Post-operative UPDRS score was improved significantly in both STN and VIM groups. However, the improvement was significantly higher in STN lesioning compared to VIM lesioning.On the other hand, the improvement in tremor component score of UPDRS was comparable in the both groups. Moreover, post-operative complications were higher following Subthalamotomy (21.05%) which included dyskinesia, dysphasia, transient weakness and hematoma formation.
 Conclusion: Both Stereotactic Subthalamotomy and VIM Thalamotomy are equally effective in relieving Parkinsonian tremor with a lower complication rate following VIM Thalamotomy.