Subthalamotomy versus Pallidotomy for Parkinsonian Rigidity: A Quasi-Experimental Study in a Resource Limited Tertiary Center

Pallidotomy vs Subthalamotomy in Parkinson’s Disease

Abstract

Objective: To compare motor outcomes and postoperative complications of subthalamotomy versus pallidotomy for Parkinsonian rigidity in a resource-limited setting where deep-brain stimulation is not affordable.

Methodology: This quasi-experimental study was carried out at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, from 2016 to 2021. Forty patients with Parkinson’s disease were included. Twenty patients underwent pallidotomy, in which a small, precisely targeted lesion was made in the globus pallidus region of the brain, and twenty had a subthalamotomy, involving a lesion in the subthalamic nucleus. Each patient’s motor function was assessed before surgery and at regular follow-ups using the Unified Parkinson’s Disease Rating Scale (UPDRS) part III, a standard measure of movement difficulty in Parkinson’s disease. Postoperative complications were also recorded. The changes in UPDRS scores and complications were compared within and between groups.

Results: The mean age was 47.6 ± 8.7 years, and 85% of patients were male. Both procedures produced significant postoperative improvement in motor scores (p < 0.001). In the pallidotomy group, the UPDRS Part III score improved from 24.9 ± 1.47 to 10.47 ± 0.86 (42% improvement), and in the subthalamotomy group from 25.48 ± 1.55 to 10.26 ± 1.18 (40.2% improvement). Although pallidotomy showed a slightly greater numerical reduction in UPDRS scores, the difference between groups was not statistically significant (p > 0.05). Complications were less frequent after pallidotomy (10%) compared with subthalamotomy (35%), but this difference was not statistically significant.

Conclusion: Both procedures are effective in treating Parkinsonian rigidity. No statistically significant difference was observed between the two procedures in terms of relief of symptoms. Fewer complications were associated with pallidotomies as compared with subthalamotomies.