Background/Aims: Operation-induced dyskinesia (OID) occurs in approximately 10% of patients submitted to subthalamotomy. The goal of the authors was to determine the possible causes of this feared complication. Methods: The 54 patients who underwent unilateral subthalamotomy were divided into two groups: the OID group (OIDG), composed of 6 patients who developed dyskinesia following the operation, and the control group (CG), consisting of 48 patients who did not present this complication. The two groups were compared regarding age; sex; presence of levodopa-induced dyskinesia (LID) and/or stimulation-induced dyskinesia (SID); side of the operation; territories of the subthalamic nucleus (STN) involved by the lesion, and degree of lesion extension towards the zona incerta (ZI). Results: The lesion involved the dorsolateral territory of the STN and was almost completely restricted to this nucleus in all patients of the OIDG, while it spread to the ZI in all but 1 patient of the CG. SID was significantly (p < 0.05) more frequent in the OIDG. There was also a strong trend favoring LID (p = 0.055). Conclusions: Damage to the dorsolateral territory of the STN and sparing of the ZI seem to be essential for the development of OID. SID and, to a lesser extent, LID are apparently significant risk factors for the development of this complication.

Obeso JA, Alvarez LM, Macias RJ, et al: Lesion of the subthalamic nucleus (STN) in Parkinson's disease (PD). Neurology 1997;48(suppl 1):A138.
Gill SS, Heywood P: Bilateral dorsolateral subthalamotomy for advanced Parkinson's disease. Lancet 1997;350:1224.
Gill SS, Heywood P: Bilateral subthalamic nucleotomy can be accomplished safely. Mov Disord 1998;13(suppl 2):201.
Patel NK, Heywood P, O'Sullivan K, McCarter R, Love S, Gill SS: Unilateral subthalamotomy in the treatment of Parkinson's disease. Brain 2003;126:1136-1145.
Alvarez L, Macias R, Guridi J, López G, Maragato C, Teijeiro J, Torres A, Alvarez E, Pavon N, Ochoa L, Juncos J, DeLong M, Obeso JA: Unilateral dorsal subthalamotomy for Parkinson's disease (PD). Mov Disord 1998;13(suppl 2):266.
Alvarez L, Macias R, Guridi J, Lopez G, Alvarez E, Maragato C, Teijeiro J, Torres A, Pavon N, Rodriguez-Oroz MC, Ochoa L, Hetherington H, Juncos J, DeLong MR, Obeso JA: Dorsal subthalamotomy for Parkinson's disease. Mov Disord 2001;16:72-78.
Alvarez L, Macias R, Lopez G, Alvarez E, Pavon N, Rodriguez-Oroz MC, Juncos JL, Maragoto C, Guridi J, Litvan I, Tolosa ES, Koller W, Vitek J, DeLong MR, Obeso JA: Bilateral subthalamotomy in Parkinson's disease: initial and long-term response. Brain 2005;128: 570-583.
Alvarez L, Macias R, Pavón N, López G, Rodríguez-Oroz MC, Rodríguez R, Alvarez M, Pedroso I, Teijeiro J, Fernández R, Casabona E, Salazar S, Maragoto C, Carballo M, García I, Guridi J, Juncos JL, DeLong MR, Obeso JA: Therapeutic efficacy of unilateral subthalamotomy in Parkinson's disease: results in 89 patients followed for up to 36 months. J Neurol Neurosurg Psychiatry 2009;80:979-985.
López-Flores G, Miguel-Morales J, Teijeiro-Amador J, et al: Anatomic and neurophysiological methods for the targeting and lesioning of the subthalamic nucleus: Cuban experience and review. Neurosurgery 2003;52:817-831.
Rodriguez MC, Guridi OJ, Alvarez L, Mewes K, Macias R, Vitek J, DeLong MR, Obeso JA: The subthalamic nucleus and tremor in Parkinson's disease. Mov Disord 1998;13(suppl 3):111-118.
Vilela Filho O, Silva DJ, Souza HAO, Cavalcante JES, Sousa JT, Ferraz FP, Silva LG, Santos LF: Stereotactic subthalamic nucleus lesioning for the treatment of Parkinson's disease. Stereotact Funct Neurosurg 2001;77:79-86.
Vilela Filho O, Silva DJ: Unilateral subthalamic nucleus lesioning: a safe and effective treatment for Parkinson's disease. Arq Neuropsiquiatr 2002;60:935-948.
Su PC, Tseng HM, Liu HM, Yen RF, Liou HH: Treatment of advanced Parkinson's disease by subthalamotomy: one-year results. Mov Disord 2003;18:531-538.
Tseng HM, Su PC, Liu HM, Liou HH, Yen RF: Bilateral subthalamotomy for advanced Parkinson disease. Surgical Neurol 2007;68(suppl 1):S43-S50.
Linazasoro G, Guridi J, Rodriguez MC, Gorospe A, Ramos E, Ruibal M, Obeso JA: Cirurgía del núcleo subtalámico en la enfermedad de Parkinson. Rev Neurol 2000;30:1066-1072.
Merello M, Tenca E, Pérez Lloret S, Martín ME, Bruno V, Cavanagh S, Antico J, Cerquetti D, Leiguarda R: Prospective randomized 1-year follow-up comparison of bilateral subthalamotomy versus bilateral subthalamic stimulation and the combination of both in Parkinson's disease patients: a pilot study. Br J Neurosurg 2008;22:415-422.
Guridi J, Herrero MT, Luquin R, Guillen J, Obeso JA: Subthalamotomy improves MPTP-induced parkinsonism in monkeys. Stereotact Funct Neurosurg 1994;62:98-102.
Guridi J, Herrero MT, Luquin MR, Guillen J, Ruberg M, Laguna J, Vila M, Javoy-Agid F, Agid Y, Hirsch E, Obeso JA: Subthalamotomy in parkinsonian monkeys. Behavioural and biochemical analysis. Brain 1996;119:1717-1727.
Guridi J, Obeso JA: The role of the subthalamic nucleus in the origin of hemiballism and parkinsonism: new surgical perspectives. Adv Neurol 1997;74:235-248.
Tomlinson FH, Jack CR, Kelly PJ: Sequential magnetic resonance imaging following stereotactic radiofrequency ventralis lateralis thalamotomy. J Neurosurg 1991;74:579-584.
Krauss JK, Desaloms JM, Lai EC, King DE, Jankovic J, Grossman RG: Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's disease: postoperative magnetic resonance imaging analysis. J Neurosurg 1997;87:358-367.
Benabid AL, Pollak P, Hoffmann D, Limousin P, Gao DM, LeBas JF, Benazzous A, Segebarth C, Grand S: Chronic stimulation for Parkinson's disease and other movement disorders; In Gildenberg PL, Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery. New York, McGraw-Hill, 1998, pp 1199-1212.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.