Objective: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by the development of motor symptoms, as well as some non-motor changes. Symptomatic treatment of PD aims to restore dopamine levels or interact with postsynaptic dopamine receptors. Pharmacotherapy is also used to alleviate the non-motor symptoms of PD.

Background: Long-term pharmacotherapy can lead to the development of levodopa-induced dyskinesias (LID), which can adversely affect the patient’s quality of life. There are three main types of LID – peak-dose, off-period, and diphasic dyskinesias. In the neurosurgical management of LID, both destructive interventions and deep brain stimulation (DBS) are widely used.

Method: In our work, we present the results of neurosurgical treatment of patients with PD with LID, in whom GPi was used as a neurosurgical target.
From 2012 to 2022, we performed 70 surgical interventions in patients with PD complicated by LID. An individual selection of the type of surgery was carried out for each patient.

Results: 22 patients underwent pallidotomy contralateral to the side of most severe dyskinesias. One week after pallidotomy, all 22 patients showed regression of contralateral dyskinesias by 60-70%. In 50% of patients in the early postoperative period, unstable regression of ipsilateral dyskinesias by an average of 43% was noted. All 22 patients achieved a positive effect in a decrease in rigidity, bradykinesia, and tremor. Half of the patients managed to reduce the dose of levodopa by an average of 10-20%. When assessed six months after surgery, the regression of contralateral LID was 50-65%, and ipsilaterally, the severity of LID returned to the preoperative level.
Forty-eight patients underwent bilateral GPi DBS. All had a regression of LID by an average of 65-75%. A positive effect was achieved in a decrease in rigidity, bradykinesia, and tremor. In 60% of cases, it was possible to reduce the dose of levodopa by an average of 15-30%. When assessed six months after surgery, the regression of LID remained at the same level.

Conclusion: GPi is a reliable and relatively safe surgical target in treating both motor symptoms of PD and LID. Pallidotomy and GPi DBS can significantly improve the quality of life of PD patients with LID. The introduction of new technologies, both destructive and varieties of DBS, will make it possible to achieve a more pronounced and prolonged regression of LID in patients with PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/globus-pallidus-as-a-neurosurgical-target-in-the-management-of-levodopa-induced-dyskinesias/