Movement disorders : official journal of the Movement Disorder Society · 2026
Target-Dependent Postoperative Weight Gain after Pallidothalamic Tractotomy versus Pallidotomy for Dystonia.
СтатьяНазвание и аннотация: Перевод в очереди
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Jozuka Ryosuke, Nishitani Masahiko, Kamijo Eriko, Kim Kilsoo, Miyao Satoru, Fujiwara Mika, Nonaka Taku, Qian Bohui, Kawamata Takakazu, Taira Takaomi, Horisawa Shiro
Аннотация
BACKGROUND: Postoperative weight gain is a recognized complication of deep brain stimulation, but whether ablative surgery produces target-dependent weight effects remains unknown. We investigated whether pallidothalamic tractotomy (PTT) causes greater weight gain than pallidotomy and explored spatial associations.
METHODS: We retrospectively analyzed 79 patients with focal, segmental, or generalized dystonia who underwent unilateral PTT (n = 41) or globus pallidus internus (GPi) lesioning (n = 38). Multivariable linear regression quantified the effect of target on weight and body mass index (BMI) changes, adjusting for age, sex, side, preoperative BMI, follow-up duration, and Burke-Fahn-Marsden dystonia rating scale (BFMDRS) improvement. In a subset with postoperative magnetic resonance imaging (MRI), lesion overlap (N) maps and voxel-wise mean BMI-change maps were generated to explore anatomical associations.
RESULTS: PTT resulted in greater postoperative weight gain than GPi lesioning (+6.7 ± 7.5 kg vs. +1.1 ± 4.7 kg), with ≥10 kg gain in 29.3% versus 5.3% of patients. After covariate adjustment, PTT remained independently associated with greater weight gain (adjusted difference + 5.18 kg; 95% confidence interval [CI] +13 to +8.23) and BMI increase (+1.92 kg/m2; 95% CI +0.85 to +2.99). Lesion mapping localized PTT lesions to Forel's field H1. Weight-gain hotspots mapped medial to the inferior border of the subthalamic nucleus, whereas GPi maps showed no consistent intranuclear hotspot.
CONCLUSIONS: PTT was associated with greater postoperative weight gain than pallidotomy, independent of covariates. These findings suggest that lesion target influences postoperative body-weight regulation, highlighting the potential risk of lesions extending into the caudal subthalamic region. © 2026 International Parkinson and Movement Disorder Society.
METHODS: We retrospectively analyzed 79 patients with focal, segmental, or generalized dystonia who underwent unilateral PTT (n = 41) or globus pallidus internus (GPi) lesioning (n = 38). Multivariable linear regression quantified the effect of target on weight and body mass index (BMI) changes, adjusting for age, sex, side, preoperative BMI, follow-up duration, and Burke-Fahn-Marsden dystonia rating scale (BFMDRS) improvement. In a subset with postoperative magnetic resonance imaging (MRI), lesion overlap (N) maps and voxel-wise mean BMI-change maps were generated to explore anatomical associations.
RESULTS: PTT resulted in greater postoperative weight gain than GPi lesioning (+6.7 ± 7.5 kg vs. +1.1 ± 4.7 kg), with ≥10 kg gain in 29.3% versus 5.3% of patients. After covariate adjustment, PTT remained independently associated with greater weight gain (adjusted difference + 5.18 kg; 95% confidence interval [CI] +13 to +8.23) and BMI increase (+1.92 kg/m2; 95% CI +0.85 to +2.99). Lesion mapping localized PTT lesions to Forel's field H1. Weight-gain hotspots mapped medial to the inferior border of the subthalamic nucleus, whereas GPi maps showed no consistent intranuclear hotspot.
CONCLUSIONS: PTT was associated with greater postoperative weight gain than pallidotomy, independent of covariates. These findings suggest that lesion target influences postoperative body-weight regulation, highlighting the potential risk of lesions extending into the caudal subthalamic region. © 2026 International Parkinson and Movement Disorder Society.