Stereotactic Thalamotomy – A Conventional But A Valuable and Effective Surgical Strategy for Parkinsonian Tremors

Objective:  To determine the frequency of improvement in tremors in Parkinsonian patients after stereotactic thalamotomy. Material & Methods:  A descriptive case series was conducted in the department of Neurosurgery Unit II, Lahore General Hospital from January 2016 to March 2020. The study included65 patients of Parkinson’s disease with tremors refractory to medicines for 6 months who fulfilled the inclusion criteria. Outcome and possible complications were explained before taking informed consent. An outcome like reduction in tremors was used as a research instrument. It was determined by a modified unified Parkinson's disease rating score (UPDRS). Patients were diagnosed based on history, clinical examination, and MRI brain by a team comprising of neurologists and neurosurgeons. Thalamotomy was done by one surgical team. Patients were examined and scored post-operatively at 3 weeks and 3 months. Improvement was labeled as a reduction in tremors upto grade 1 or more from baseline after thalamotomy. Results:  Improvement in tremors after thalamotomy was observed in 58.5% of patients whereas there was no improvement in tremors after thalamotomy in 41.5% of patients. There was no significant association between age and improvement in tremors after thalamotomy (p-value = 0.786). No significant association was found between the duration of medical treatment and improvement in tremors after thalamotomy (p-value = 0.681). Conclusion:  Improvement in tremors after thalamotomy was observed in 58.5% of parkinsonian patients. Effect modifiers like age and duration of medical treatment were not significantly associated with improvement in tremors after thalamotomy.