The long-term results of stereotaxic surgery and L-dopa therapy in patients with Parkinson's disease

Abstract

Patients [60] with Parkinson''s disease underwent sterotaxic surgery between 1965-1967 and were examined every 2 yr for a total follow-up period of 10 yr. Although sterotaxic surgery was extremely effective in treating tremor and regidity, the other manifestation of Parkinson''s disease were noted to progressively affect more patients at each follow-up examination. L-dopa therapy was instituted in 36 patients after 1968. The effect of L-dopa on bradykinesia was remarkable, but the long-term benefit on the other manifestations of Parkinson''s disease was negligible. In most cases L-dopa became progressively ineffective for bradykinesia after 3-5 yr. L-dopa-induced tremor and involuntary movements were less frequently noted in limbs contralateral to the side of a previous sterotaxic procedure. In patients presenting tremor and rigidity as the major problem in their parkinsonial syndrome, the most effective form of palliative therapy is sterotaxic surgery. L-dopa should be reserved for the management of bradykinesia.