A qualitative and quantitative evaluation of parkinsonians three to six years following thalamotomy

Seventy-eight patients with parkinsonism have been assessed over a postoperative interval of 3–6 years from 3 major aspects: (1) history and physical examination, (2) specific psychological tests, and (3) a battery of clinical quantitative neurological tests. The results were separated into the effects of (1) the first thalamotomy, (2) the second thalamotomy, and (3) thalamotomy plus <i>L</i>-dopa therapy. <i>1. The first thalamotomy. </i>Contralateral tremor and rigidity both responded well to surgery in the qualitative and quantitative evaluations and remained at an improved level for about three years. Although general function was also usually improved over this interval, removal of tremor and rigidity did not guarantee functional improvement. Progression in bradykinesia, speech and mental symptoms did not change with thalamotomy. <i>2. The second thalamotomy. </i>The results were similar but not as good quantitatively nor as enduring as those of the first thalamotomy. An adverse effect on mental symptoms was seen more frequently. <i>3. Thalamotomy plus </i><i>L</i><i>-dopa. </i>The drug appeared to have specific action on bradykinesia, appeared synergistic with surgery in relieving rigidity and to a lesser degree, tremor. <i>L</i>-Dopa-resistent tremor responded to thalamotomy as well as the general tremor category in the pre-<i>L</i>-dopa period. Thalamotomy usually prevents iatrogenic <i>L</i>-dopa-induced dyskinesias in the limbs contralateral to the side of surgery, but had no certain effect upon the commoner facial and axial dyskinesias.