EVALUATION OF THE EFFECT OF TREATMENT ON MOVEMENT-DISORDERS IN ASTROCYTOMAS OF THE BASAL GANGLIA AND THE THALAMUS

Twenty patients with movement disorders associated with astrocytomas ( grade I-IV according to the WHO tumour classification) of the basal ga nglia and the thalamus were evaluated for the effects of treatment. Fi ve patients had more than one movement disorder when the histological diagnosis was verified by stereotactic biopsy. Twelve had tremors, eig ht hemidystonia, three hemichorea, and one hemichorea/ballismus, and m yoclonus respectively. Ten patients died during the follow up period, and for the surviving patients follow up periods ranged from 6-21 year s. The movement disorders changed over long periods of time related to therapeutic interventions. CSF shunt operations and percutaneous radi otherapy had no definite effect on the movement disorders. There was a moderate response to medical treatment in a few patients. Stereotacti c aspiration of tumour cysts had a marked influence on the movement di sorder in two patients, and functional stereotactic surgery abolished tumour induced tremor in one. Interstitial radiotherapy was performed in fifteen patients for treatment of the underlying neoplasm and resul ted in different and variable alterations of the movement disorders. T hese differences may be explained by complex interactions involving st ructures affected primarily by the tumour, as well as by secondary fun ctional lesions of adjacent structures.