Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine

Merello, M.; Perez-Lloret, S.; Antico, J.; Obeso, J. A.
February 2006
Journal of Neurology, Neurosurgery & Psychiatry;Feb2006, Vol. 77 Issue 2, p172
Academic Journal
Background: Dyskinesias are a transient but severe complication of subthalamotomy in some patients. Patients and methods: Three patients with Parkinson's disease undergoing bilateral micro-recording guided surgery of the subthalamic nucleus (STN) are described; deep brain stimulation (DBS) was used in one case, and subthalamotomy in the other two. Prior to surgery, levodopa induced dyskinesia had improved (⩽50%) under treatment with amantadine (400 mg/day, po) in all three patients. The patient treated with DBS developed severe dyskinesia a few days after discharge and began self medication with amantadine but showed no improvement. This suggested a possible lack of response to amantadine for treatment of dyskinesias induced by surgery of the STN. Results: Both patients treated with bilateral subthalamotomy developed unilateral choreoballistic movements immediately after surgery, despite not taking levodopa (L-dopa). Patients were scored using the dyskinesia scale and started treatment with 400 mg amantadine (po) for 4 days within the first postoperative week with no effect on dyskinesia score or its phenomenology. Amantadine was therefore discontinued. One month after surgery both patients were free of involuntary movements with an improvement of about 60% in the ‘off’ state UPDRS motor score. Six month follow up showed maintained antiparkinsonian benefit, without need for levodopa treatment and complete absence of dyskinesia. Conclusion: The present findings suggest that: (i) amantadine probably exerts its anti-dyskinetic effect by acting on the ‘indirect’ pathway; (ii) the pathophysiological mechanisms of subthalamotomy induced dyskinesias may differ from those involved in L-dopa induced dyskinesias; (iii) dyskinesias induced by STN surgery resolve spontaneously as compensatory mechanisms develop.


Related Articles

  • The Use of Amantadine HCL in Clinical Practice: A Study of Old and New Indications. Singer, Carlos; Papapetropoulos, Spiridon; Uzcategui, Gadith; Vela, Lydia // Journal of Applied Research;2006, Vol. 6 Issue 3, p240 

    Since the discovery of the anti-dyskinetic properties of amantadine, there has been a renewed interest in its use. To evaluate its efficacy and tolerability, we performed a retrospective study of consecutive patients with Parkinson's disease (PD) who had received amantadine either as mono- or...

  • Development of an Activity Scale for Individuals With Advanced Parkinson Disease: Reliability "On-Off" Variability. Nieuwboer, Alice; De Weerdt, Willy; Dom, Rene; Bogaerts, Kris; Nuyens, Godelieve // Physical Therapy;Nov2000, Vol. 80 Issue 11, p1087 

    Provides information on a study which investigated the impact of dyskinesias on and the reliability of the measurement of functional mobility in advanced Parkinson's disease patients. Method; Results and discussion; Conclusion.

  • Reliability of Measurements Obtained With the Timed "Up & Go" Test in People With Parkinson Disease. Morris, Susan; Morris, Meg E. // Physical Therapy;Feb2001, Vol. 81 Issue 2, p810 

    Provides information on a study which investigated the reliability of the Timed Up & Go Test in detecting changes in mobility in subjects with idiopathic Parkinson disease. Methods; Results and discussion; Conclusion.

  • Ataxic arm movements after thalamotomy for Parkinsonian tremor. Kimber, T. E.; Brophy, B. P.; Thompson, P. D. // Journal of Neurology, Neurosurgery & Psychiatry;Feb2003, Vol. 74 Issue 2, p258 

    Voluntary finger-nose movements of the arm were analysed in six patients undergoing stereotaxic nucleus ventralis intermedius thalamotomy for relief of severe Parkinsonian tremor. In all cases thalamotomy acutely abolished tremor in the contralateral arm. In the early postoperative phase, ataxia...

  • Gene Therapy Reverses Symptoms.  // USA Today Magazine;Oct2012, Vol. 141 Issue 2809, p6 

    The article discusses a randomized , double-blind clinical trial conducted by Michael Kaplitt and Matthew During and published in "Lancet Neurology," which reveals that a gene therapy called NLX-P101 significantly reduces movement impairment in Parkinson's disease patients.

  • Analysis of age of onset and epidemiological factors in Parkinsons Disease. Sankhla, C.; Peswani, Namrata; Pimple, Priyadarshani // Annals of Indian Academy of Neurology;2007 Supplement 2, Vol. 10, p42 

    Objective: To study the age of onset in Parkinsons Disease [PD] and study the causative and protective factors in PD in outpatients clinic in Mumbai. The patients selected were typical PD patients fulfilling UK brain bank criteria and were examined by movement disorders specialist in outpatients...

  • Amantadine for Dyskinesias in Parkinson's Disease: A Randomized Controlled Trial. Sawada, Hideyuki; Oeda, Tomoko; Kuno, Sadako; Nomoto, Masahiro; Yamamoto, Kenji; Yamamoto, Mitsutoshi; Hisanaga, Kinya; Kawamura, Takashi // PLoS Clinical Trials;Dec2010, Vol. 7 Issue 12, Special section p1 

    Background: Dyskinesias are some of the major motor complications that impair quality of life for patients with Parkinson's disease. The purpose of the present study was to investigate the efficacy of amantadine in Parkinson's disease patients suffering from dyskinesias. Methods: In this...

  • TIMING OF FUNCTIONAL MOVEMENTS FOR INDIVIDUALS WITH PARKINSON'S DISEASE. Light, K. E.; Behrman, A. L.; Flynn, S. M.; Bowers, D.; Friedman, W. A. // Gerontologist;Oct1996 Supplement, Vol. 36 Issue 1, p133 

    Individuals with Parkinson's Disease (PD) have difficulty with movement initiation, sequencing and speed. The Timed Functional Movements (TFMs) battery was developed as a sensitive and reliable assessment to document movement difficulty in elderly clients. The purpose of this study was to...

  • Myerson's sign.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p1526 

    A reference entry for the term "Myerson's sign" is presented, which refers to the repeated blinking of the eyes of patients with Parkinson's disease.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics