Long-Term Follow-up of Unilateral Pallidotomy in Advanced Parkinson's Disease (original) (raw)
Related papers
Posteroventral medial pallidotomy in Parkinson’s disease
Journal of Neurology, 1999
There has been a resurgence in the use of functional neurosurgery for Parkinson's disease. An important factor that has played a role in this development is the recent understanding of the functional anatomy of the basal ganglia including a knowledge of the changes in the activities of neurons in the internal segment of the globus pallidus (GPi) and the subthalamic nucleus (STN) in Parkinson's disease as well as the knowledge of the presence of segregated functional loops within the basal ganglia which include a sensory-motor loop that involves the posteromedial globus pallidus rather than the anterior GPi where earlier pallidotomy lesions had been made. Laitinen reintroduced the modern posteroventral medial pallidotomy (PVMP) in 1992. Since then it has become clear that this treatment has major effects on levodopa-induced dyskinesias and, unlike Vim thalamotomy, improves bradykinesia and rigidity as well as tremor. In this report, we review a number of topics related to PVMP including the clinical results of pallidotomy available in the literature as well as an update of our own 2 year follow-up data, studies evaluating factors that might predict the subsequent response to pallidotomy, the neuropsychological effects of the procedure, results of imaging studies including the correlation of clinical effects with lesion location, the question of bilateral pallidotomy and pallidotomy combined with deep brain stimulation and finally whether PVMP is effective in other parkinsonian disorders.
Long term outcome of unilateral pallidotomy: follow up of 15 patients for 3 years
2000
Objectives-With the advent of new antiparkinsonian drug therapy and promising results from subthalamic and pallidal stimulation, this study evaluated the long term eYcacy of unilateral pallidotomy, a technique which has gained popularity over the past decade for the management of advanced Parkinson's disease. Methods-The 15 patients reported here are part of the original cohort of 24 patients who underwent posteroventral pallidotomy for motor fluctuations and disabling dyskinesias 3 years ago as part of a prospective study. Evaluation scales included the unified Parkinson's disease rating scale, the Goetz dyskinesia scale, and the Purdue pegboard test.
Journal of Neurosurgery, 1999
NILATERAL pallidotomy is now widely recognized as one alternative in the treatment of severe Parkinson's disease (PD) that features medically intractable fluctuations, especially in young patients. 113 Improvement has been reported in parkinsonian signs and levodopa-induced dyskinesias, especially in bradykinesia and rigidity, but less in tremor or gait abnormalities and is probably the result of some restoration of the thalamocortical activation function. Bilateral pallidotomy is probably more efficient than unilateral lesioning but has a high percentage of side effects including 25 to 30% dysarthria and cor-ticobulbar syndromes. Bilateral pallidal stimulation according to Siegfried's technique yields similar results with reversible or controllable side effects.
Reassessment of unilateral pallidotomy in Parkinson's disease: A 2-year follow-up study
Brain, 1999
Unilateral pallidotomy has gained popularity in treating the motor symptoms of Parkinson's disease. We present the results of a 2-year post-pallidotomy follow-up study. Using the Unified Parkinson's Disease Rating Scale (UPDRS), the Goetz dyskinesia scale and the Purdue Pegboard Test (PPBT), we evaluated 20 patients at regular intervals both off and on medications for 2 years postpallidotomy. There were no significant changes in the dosages of antiparkinsonian medications from 3 months pre-pallidotomy to 2 years post-pallidotomy. On the side contralateral to the operation, the improvements were preserved in 'on'-state dyskinesia (83% reduction from pre-pallidotomy to 2 years post-pallidotomy, P < 0.001) and 'off'-state tremor (90% reduction from pre-
Randomized trial of pallidotomy versus medical therapy for Parkinson's disease
Annals of Neurology, 2003
Thirty-six patients with Parkinson's disease (PD) were randomized to either medical therapy (N ؍ 18) or unilateral GPi pallidotomy (N ؍ 18). The primary outcome variable was the change in total Unified Parkinson's Disease Rating Scale (UPDRS) score at 6 months. Secondary outcome variables included subscores and individual parkinsonian symptoms as determined from the UPDRS. At the six month follow-up, patients receiving pallidotomy had a statistically significant reduction (32% decrease) in the total UPDRS score compared to those randomized to medical therapy (5% increase). Following surgery, patients' showed improvement in all the cardinal motor signs of PD including tremor, rigidity, bradykinesia, gait and balance. Drug-induced dyskinesias were also markedly improved. Although the greatest improvement occurred on the side contralateral to the lesion, significant ipsilateral improvement was also observed for bradykinesia, rigidity and drug-induced dyskinesias. A total of twenty patients have been followed for 2 years to assess the effect of time on clinical outcome. These patients have shown sustained improvement in the total UPDRS ( p < 0.0001), "off" motor ( p < 0.0001) and complications of therapy subscores ( p < 0.0001). Sustained improvement was also seen for tremor, rigidity, bradykinesia, percent on time and drug-induced dyskinesias.
Brain, 1997
We tested the efficacy, stability and predictors of outcome of improvement in Unified Parkinson's Disease Rating Scale motor scores in the OFF state increased with age. The unilateral pallidotomy used to treat patients with Parkinson's disease inadequately controlled with pharmacotherapy (IP). improvement in total dyskinesia scores occurred irrespective of age, but increased with duration of disease, duration of The surgical procedure was as simple as possible; we used CT rather than MRI, and we omitted microelectrode dyskinesias and baseline severity of dyskinesias. Five patients had transient neurological complications while facial paresis recording. We studied 24 patients with IP; 22 of these patients had drug-induced dyskinesias. There was a significant and was permanent in one subject. Our results are similar to those obtained by others who used the time consuming stable improvement in all the major parkinsonian motor signs in the OFF (medication) state on the contralateral side. microelectrode recording technique for localization. By simplifying the procedure in the way that we describe, the In the ON (medication) state peak-dose dyskinesias were alleviated on the contralateral side. The only significant and operation could become available to a greater number of patients. stable change on the ipsilateral side was improvement in dyskinesias less marked than on the contralateral side. The
Arquivos de Neuro-Psiquiatria, 2000
Twenty-three patients with Parkinson's disease underwent stereotactic surgery. To study the long-term motor performance, the patients were evaluated at the pre-operative period and at the 1st, 3rd, 6th, and 12th post-operative months, with the following scales: Unified Parkinson's Disease Rating Scale (UPDRS) motor score and Larsen's Scale for Dyskinesias. The patients under levodopa therapy were assessed both in "on" and "off" periods. Fourteen unilateral ventrolateral thalamotomies (VLT), 4 unilateral posteroventral pallidotomies (PVP), 2 bilateral PVP, and 3 VLT with contralateral PVP were performed. The motor improvement was significant and long-lasting in the "off" period, except for 2 patients. The "on" period quality improved, mainly due to the control of dyskinesias. The improvement of dyskinesias was long-lasting for the majority of the patients. There was no significant decrease in the levodopa dose. Three patients showed...
Journal of Neurosurgery, 2003
HERE is considerable evidence that unilateral PVP is an effective treatment for cardinal motor signs, motor fluctuations, and levodopa-induced dyskinesia in patients with advanced PD. Improvement of dyskinesia is most striking, and at present PVP is one of the most widely available and reliable surgical treatments for this common complication of advanced PD. The ultimate location of stereotactic lesions in PVP varies, 20,26,33 and lesions that extend structurally or functionally beyond the sensorimotor region of the globus pallidus internus 2 might be expected to alter cognitive and mood/motivational functioning.
Brain, 1998
Intellectual, psychological and functional outcomes were evaluated in a consecutive series of 20 Parkinsonian patients who had unilateral (UPVP) or simultaneous bilateral posteroventral pallidotomy (BPVP) using Image Fusion TM and Stereoplan TM (Radionics Inc., Boston, Mass., USA) with stimulation for lesion localization. Comprehensive baseline and 3-month postoperative neuropsychological and neurological assessment protocols were administered together with questionnaire measures of functional disability, quality of life and psychological symptomatology. Changes in patients' clinical presentation and scores on psychometric tests, questionnaires and observational rating scales were then examined. We observed no new neuropsychiatric sequelae directly related to pallidotomy. Cognitive sequelae were restricted to selective reductions in categorical verbal fluency following UPVP (P Ͻ 0.001) and BPVP (P Ͻ 0.01) and a
Unilateral pallidotomy for Parkinson’s disease: results after more than 1 year
Journal of Neurology Neurosurgery and Psychiatry, 1999
OBJECTIVETo examine follow up results of unilateral ventral medial pallidotomy in 22 patients with advanced Parkinson’s disease more than 1 year after the operation in comparison with their results (previously reported) at 3 months.METHODSTwenty patients who had undergone unilateral pallidotomy were assessed with the core assessment programme for intracerebral transplantation (CAPIT) protocol preoperatively, at 3 months postoperatively, and again after