Posteroventral medial pallidotomy in Parkinson’s disease (original) (raw)
Related papers
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.
Thalamotomy, pallidotomy and subthalamotomy in the management of Parkinson's disease
Current and Future Therapeutics and Clinical Trials, 2000
Chapter higher effectiveness for tremor and an equal response to rigidity, with fewer complications than pallidotomy . However, bradykinesia relief received little attention at that time. Lesions in the posterior part of the ventrolateral thalamus (ventral oral posterior [VOP] and ventral intermediate nucleus [VIM]) were effective for tremor, and lesions in the anterior part (ventro oralis anterior [VOA]) were better for rigidity and levodopa (l-DOPA)-induced dyskinesias. Lesions in the subthalamic region (Forel's field H and zona incerta) were published a few years later than pallidotomy and thalamotomy, with comparable results, but were then abandoned for a long time .
European Journal of Neuroscience, 2008
Parkinson's disease (PD) patients with prior radio-frequency lesions in the internal segment of the globus pallidus (GPi, pallidotomy), whose symptoms have deteriorated, may be candidates for further invasive treatment such as subthalamic deep brain stimulation (STN DBS). Six patients with prior pallidotomy (five unilaterally; one bilaterally) underwent bilateral STN DBS. The microelectrode recordings (MERs, used intraoperatively for STN verification), ipsilateral and contralateral to pallidotomy, and MERs from 11 matched PD patients who underwent bilateral STN DBS without prior pallidotomy were compared. For each trajectory, average, variance and mean successive difference (MSD, a measure of irregularity) of the root mean square (RMS) of the STN MER were calculated. The RMS in trajectories ipsilateral to pallidotomy showed significant reduction of the mean average and MSD of STN activity when compared with trajectories from patients without prior pallidotomy. The RMS parameters contralateral to pallidotomy tend to lie between those ipsilateral to pallidotomy and those without prior pallidotomy. The average STN power spectral density of oscillatory activity was notably lower ipsilateral to pallidotomy than contralateral, or without prior pallidotomy. The finding that pallidotomy reduces STN activity and changes firing characteristics, in conjunction with the effectiveness of STN DBS despite prior pallidotomy, calls for reappraisal and modification of the current model of the basal ganglia (BG) cortical network. It highlights the critical role of direct projections from the BG to brain-stem structures and suggests a possible GPi-STN reciprocal positive-feedback mechanism.
Parkinsonism & Related Disorders, 2019
Background: Pallidal deep brain stimulation (DBS) has shown to be beneficial in patients with advanced levodopa-responsive Parkinson's disease (PD) in several short-term studies. However, reported long-term outcomes of pallidal DBS for PD are limited and contradictory. Methods: Eighteen consecutive PD patients were treated with unilateral or bilateral stimulation of the internal part of the globus pallidus (GPi). Assessments were carried out before and six months after neurosurgery, and annually thereafter for up to 16 years (mean follow-up time: 6 years). Primary outcomes included motor signs (Unified PD Rating Scale [UPDRS]-III), activities of daily living (ADL, UPDRS-II), and levodopa-induced motor complications (UPDRS-IV). Results: The results show that GPi stimulation improves levodopa-responsive PD motor signs (UPDRS-III), levodopa-induced motor complications (UPDRS-IV), and ADL (UPDRS-II) in advanced PD. Among motor signs, tremor showed the best response to pallidal stimulation. Levodopa-induced motor complications and tremor showed improvements for more than 10 years after neurosurgery. Conclusions: The overall findings in our cohort demonstrate that pallidal stimulation is effective in reducing parkinsonian motor signs (UPDRS-III), particularly in the 'off'-medication state. Although the beneficial effects on bradykinesia, rigidity and ADL may be limited to 5-6 years, the follow up results indicate that the improvements of levodopa-induced motor complications (UPDRS-IV) and tremor can be sustained for more than 10 years. report on long-term results (up to 16 years) in a cohort of 18 PD patients treated with pallidal DBS and prospectively followed at the University Hospital of Bern. 1.1. Patients Our cohort is a consecutive series of 18 patients (11 male and 7 female; mean age at time of surgery 64.8 ± 7.4 years) with advanced PD (mean disease duration at time of surgery 16.2 ± 6.8 years) who received unilateral (n = 4) or bilateral (n = 14) electrode implantations for DBS of the GPi at the University Hospital of Bern. The selection criteria for neurosurgery included: (i) advanced PD; (ii) good response
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...