The first and foremost unilateral pallidothalamic tractotomy done in India for Parkinson’s Disease: An interesting case report

Background. Pallidothalamic tractotomy” can be effective in Parkinson’s disease by exhibiting anti-parkinsonian effects. Case presentation. The patient was a 53 years old gentleman, having Parkinson’s disease for the last 14 years. The disease onset was on the left side and slowly moved to the right side. He had tremors, slowness of body movements and stiffness of the movements. The first right Pallidotomy was done in January 2019. There was a noticeable improvement in a few weeks. He continued to have symptoms on the right side. The preoperative Unified Parkinson Disease Rating Scale (UPDRS) part 3 score in 2019 was 53 while the postoperative score was only 26 showing drastic improvement after right Pallidotomy. After 2 years of the first surgery, a new technique called Pallido Thalamic Tractotomy (PTT), an MRI-guided stereotactic surgery was done on the left side. Tremors reduced gradually by 99% in 3 weeks after surgery. This is the first case of PTT performed on a patient with Parkinson’s disease in India. Conclusion. PTT is an effective procedure in PD that acts by disconnecting the pallidothalamic tract. Unilateral pallidothalamic tractotomy done on the left side improved contralateral side rigidity, tremors and bradykinesia.