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  • Long Term Follow-up for Thalamotomy and Pallidotomy for the Treatment of Medication-resistant Hemiballismus

    Final Number:

    Marcello Penholate Faria MD; George De Albuquerque Cavalcanti-Mendes MD; Gervásio Cardoso Teles Carvalho MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Stereotactic neurosurgery remains as a final option in severe cases of medication-resistant hemiballismus, but is only necessary in a small proportion of patients. Surgical options include thalamotomy and pallidotomy, both carried out alone. These procedures were reported in a few number of cases.

    Methods: Four patients underwent stereotactic ablative neurosurgery. The clinical data were reviewed using the objective hemiballismus/hemichorea outcome rating score (HORS). All patient with a history of severe disabling, involuntary movement HORS = 4 to HORS =3.

    Results: Two of our four patients, who underwent combined pallidotomy (GPi) /thalamotomy (Vim-Vop), presented an excellent outcome, with a mild but definite difference from the two others patients who reported improvement but not total relief

    Conclusions: The combined thalamotomy and pallidotomy is a valid option for the treatment of medication-resistant hemiballismus.

    Patient Care: Through an optimal approach to such hemiballismus patients.

    Learning Objectives: By the conclusion of the session, participants should be able to identify an treatment option for drug-resistant hemiballismus patients.

    References: 1.Tsubokawa T, Katayama Y, Yamamoto T. Control of persistent hemiballismus by chronic thalamic stimulation: report of two cases. J Neurosurg 1995; 82: 501–05. 2. Krauss JK, Mundinger F. Functional stereotactic surgery for hemiballism. J Neurosurg 1996; 85: 278-86. 3. Levesque MF, Markham CH. Ventral intermediate thalamotomy for posttraumatic hemiballismus. Stereotact Funct Neurosurg 1992; 58: 26–29. 4. Goto S, Kunitoku N, Hamasaki T, Nishikawa S, Ushio Y. Abolition of postapoplectic hemichorea by Vo-complex thalamotomy: long-term follow-up study. Mov Disord 2001; 16: 771–74. 5. Cardoso F, Jankovic J, Grossman RG, Hamilton WJ. Outcome after stereotactic thalamotomy for dystonia and hemiballismus. Neurosurg 1995; 36: 501–07. 6. Bullard DE, Nashold BS Jr: Stereotaxic thalamotomy for treatment of posttraumatic movement disorders. J Neurosurg 1984; 61:316–21. 7. Jallo GI, Dogali M: Ventral intermediate thalamotomy for hemiballismus. Stereotact Funct Neurosurg 1995; 65:23–25. 8. Kandel EI: Treatment of hemihyperkinesias by stereotactic operations on basal ganglia. Appl Neurophysiol 1982; 45:225–29.

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