Pallidothalamic Tractotomy for Parkinson Disease with 1-Year Follow-Up: A Case Report

Abstract

The pallidothalamic tract connects the globus pallidus internus and the ventrolateral portion of the thalamus, and ablation of the pallidothalamic tract (pallidothalamic tractotomy [PTT]) reportedly exerts antiparkinsonian effects. However, the detailed clinical course has not yet been elucidated. Here, we present the first single case report of PTT performed in a patient with Parkinson disease, with 1-year follow-up. The patient was a 68-year-old woman with Parkinson disease. After 14 years of receiving oral medication, she experienced the "wearing-off" phenomenon. Levodopa (300 mg/day) was required to maintain daily activities. Rigidity and peak-dose dyskinesia were predominantly observed in the right side of her body. In addition, she demonstrated right foot dystonia with pain. The preoperative Unified Parkinson Disease Rating Scale part 1, 2 (off medication/on medication), 3 (off medication/on medication), and 4 scores were 7, 26/4, 41/23, and 13, respectively. Further, the preoperative Unified Dyskinesia Rating Scale and Parkinson Disease Questionnaire-39 scores were 102 and 46, respectively. She underwent left-sided PTT, and no perioperative complications were observed. At 1 year postoperatively, daily administration of levodopa (200 mg) was maintained without an "off" condition all day. The 1-year Unified Parkinson Disease Rating Scale part 1, 2, 3, and 4 scores were 5, 9/1, 20/12, and 5, respectively. In addition, the 1-year Unified Dyskinesia Rating Scale and Parkinson Disease Questionnaire-39 scores were 20 and 20, respectively. We present a rare case of PTT performed in a patient with Parkinson disease. PTT might be useful in patients who do not desire device implantation.