The thesis is devoted to topical issues of surgery for levodopa treatment motor complications of Parkinson's disease (PD). 90 patients with PD aged 31 to 77 years (average - 58,1 ± 0,9 years) were enrolled in study. Depending on the type of stereotactic interventions patients were divided into five groups: group Vim - 31 (34,4 %) patients underwent unilateral thalamotomy, group GPi - 18 (20,0 %) patients underwent unilateral pallidotomy, group Vim-GPi - 15 (16,7 %) patients underwent thalamotomy and contralateral pallidotomy, group Vim-STN - 12 (13,3 %) patients underwent thalamotomy and contralateral subthalamotomy; group DBS-STN of 14 (15,6 %) patients underwent implantation systems for bilateral neurostimulation of the subthalamic nuclei (STN). Postoperative follow-up ranged from 6 months to 10,5 years (average 5,8 ± 1,1 years). Predictive factors of levodopa-induced motor disturbances have been identified as following. The high efficiency and safety of unilateral ablative interventions have been demonstrated. Unilateral thalamotomy improved UPDRS score by 53,0 % in ON period, by 47,4 % in OFF period, eliminated tremor in 96,8 % and rigidity in 83,3 % cases. After pallidotomy UPDRS score improved by 55,0 % in ON period and by 50,2 % in OFF period, tremor eliminated in 75,0 % and rigidity in 88,9 % cases. Motor fluctuations (MF) and levodopa-induced dyskinesia (LID) abolished in 61,3 % and 41,2 % patients after unilateral thalamotomy and in 63,6 % and 88,9 % patients after unilateral pallidotomy correspondingly. Stereotactic thalamotomy and subsequent contralateral pallidotomy eliminated tremor and rigidity in over 70,0 % cases, regression of hypokinesia was observed in 60,0 % of patients. In this group LID have stopped in 81,8 % and MF - in 73,3 % cases. Surgical complications occurred in 2 (13,3 %) patients. Stereotactic thalamotomy and subsequent contralateral subthalamotomy eliminated tremor and rigidity in 91,7 % and 80,0% cases correspondingly. In this group hypokinesia did not regress, but MF abolished in 83,3 % patients. After subthalamotomy hemibalism occurred in 2 (17,0 %) patients. Predictive factors of development hemiballism have been identified. They include extensive volume of lesion and short term between two interventions (less than 4 years). The best results were achieved in patients who underwent DBS of STN. Tremor, rigidity and hypokinesia have been eliminated in 100,0 % cases. In this group UPDRS score improved by 81,7 % in ON period and by 74,5 % in OFF period. In compare with other interventions, DBS treatment has been noticed most significant reduction dose of levodopa - by 51,2 %. MF eliminated - in 92,3 % and LID - in 91,7 % cases.
