Evaluating the Effect of Lesioning Surgeries on Levodopa Equivalent Daily Dose in Idiopathic Parkinson's Disease

BACKGROUND: Brain ablation techniques are re-emerging as cost-effective alternatives to deep brain stimulation (DBS) in managing Parkinson’s disease (PD). These methods include thalamotomy, pallidotomy, subthalamotomy, and combined thalamotomy and pallidotomy aiming to improve motor symptoms and reduce medication requirements in patients with PD.OBJECTIVE: To assess the efficacy of four brain ablation techniques in improving motor symptoms, as measured by the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, and reducing levodopa equivalent daily doses (LEDD) in patients with PD.METHODS: A prospective non-randomized study included 100 patients with PD who underwent thalamotomy, pallidotomy, subthalamotomy, or combined thalamotomy and pallidotomy. MDS-UPDRS Part III scores in "off" and "on" states and LEDD were evaluated preoperatively. Statistical analyses were conducted to compare changes across groups within 6 months follow up period. Postoperative complications were also documented.RESULTS: Six months postoperatively, significant reductions were observed in MDS-UPDRS scores and LEDD across the four studied groups. Subthalamotomy group demonstrated the most substantial improvements, with MDS-UPDRS "off" scores decreasing from 54.56 ± 6.07 to 28.32 ± 6.30 (P = 0.000012) and LEDD dropping from 770.00 ± 227.30 to 380.00 ± 116.82 (P = 0.00001). A statistically significant correlation between LEDD reduction and symptom improvement was noted in the pallidotomy (Rho = 0.424, p = 0.035) and subthalamotomy (Rho = 0.398, p = 0.049) groups.CONCLUSION: For patients with PD, brain ablation techniques can be significantly effective in improving the motor symptoms and in reducing the medication requirements.