1
|
Navarro-Olvera JL, Velasco-Campos F, Jiménez-Ponce F, Aguado-Carrillo G, Beltrán JQ, Armas-Salazar A, Carrillo-Ruiz JD. Prognostic factors of unilateral prelemniscal radiations radiofrequency lesions: A surgical technique for the treatment of Parkinson's disease motor symptoms. Clin Neurol Neurosurg 2023; 225:107588. [PMID: 36640737 DOI: 10.1016/j.clineuro.2023.107588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 12/07/2022] [Accepted: 01/07/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE A group of patients with Parkinson's disease (PD) were managed with unilateral prelemniscal radiation radiofrequency lesions (U-Raprl). The current study aims to evaluate prognostic factors that could influence clinical response. METHODS Patients previously diagnosed with PD managed with U-Raprl were included in the study, classifying them into two groups according to their percentage of clinical response (</≥ 50%) at 5 years of follow-up in relation to the part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III), analyzing the possible factors associated with their response (age, evolution of PD, Hoehn and Yahr scale (HYS), and levodopa dose). To show differences between groups before and after the intervention, a T-test was performed, and a Mann-Whitney U test was carried out to determine differences between the response groups, added to an effect size calculation using a Cohen's d (α = 0.05, and β = 0.20). RESULTS Thirty-four patients were included, where the most prevalent symptoms were tremor and rigidity, with 52.9% percentage of males, 59.3 ± 6.4 mean age, and 7.4 ± 2.1 of mean evolution of PD. Analysis shows differences between groups (p < 0.05) according to the HYS, UPDRS, and levodopa intake, after the intervention. The analysis of the groups according to their response showed differences between the HYS (p < 0.01, ∆ > 1.5), Age (p < 0.0001, ∆ = 2.38), Evolution (p < 0.0001, ∆ = 2.38), and post-operative UPDRS (p < 0.01, ∆ = 1.38). The qualitative analysis of the distribution regarding the responder group shows that those patients with an age under 58 years, an evolution fewer than 7 years, and a preoperative HYS score smaller than 2, showed a response ≥ 50% according to the UPDRS-III in all cases. CONCLUSION U-Raprl is a highly effective procedure with a 5-year persistence of improvement. The most relevant prognostic factors to consider for a clinical response according to UPDRS-III greater than 50% are age under 58 years, less than 7 years of PD evolution, and HYS less or equal to 3.
Collapse
Affiliation(s)
- José Luis Navarro-Olvera
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Francisco Velasco-Campos
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - Fiacro Jiménez-Ponce
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - Gustavo Aguado-Carrillo
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - Jesús Q Beltrán
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - Armando Armas-Salazar
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico; Postgraduate department, School of Higher education in Medicine, National Polytechnic Institute, Mexico City, Mexico
| | - José Damián Carrillo-Ruiz
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico; Research Direction of General Hospital of Mexico, Mexico City, Mexico; Neuroscience coordination, Psychology Faculty, Anahuac University Mexico, Mexico City, Mexico.
| |
Collapse
|
2
|
Parkinson’s Disease: Lesions. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
3
|
Fayed ZY, Radwan H, Aziz M, Eid M, Mansour AH, Nosseir M, Anwer H, Elserry T, Abdel Ghany WA. Combined Unilateral Posteroventral Pallidotomy and Ventral Intermediate Nucleus Thalamotomy in Tremor-Dominant Parkinson's Disease versus Posteroventral Pallidotomy Alone: A Prospective Comparative Study. Stereotact Funct Neurosurg 2018; 96:264-269. [PMID: 30227440 DOI: 10.1159/000492229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 07/18/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The optimum target in surgery for Parkinson's disease (PD) is still controversial, especially in patients with tremor-dominant PD. We aim to compare results in tremor-dominant patients undergoing pallidotomy vs. those undergoing simultaneous posteroventral pallidotomy (PVP) and ventral intermediate nucleus (VIM) thalamotomy. METHODS Twenty-four patients with tremor-dominant PD were included in this study. Twelve patients received unilateral PVP contralateral to the most affected side. The other 12 patients received simultaneous unilateral PVP and VIM thalamotomy contralateral to the most affected side. Assessment of results in both groups was achieved using both UPDRS "off" motor scores and UPDRS rest tremor subscores. RESULTS The mean UPDRS off motor score improved in the pallidotomy group from 61.3 preoperatively to 36.8 at 12 months. In the combined group, it improved from 59.6 to 35.2 at 12 months, with no statistically significant difference between both groups. On the other hand, while the mean tremor subscore in the pallidotomy group improved from a mean of 2.3-0.8, the tremors were abolished in all of the patients in the combined group except for 1 patient who showed slight infrequent tremors at 12 months. CONCLUSION Patients with tremor-dominant PD achieve more improvement in tremor control after combined PVP and VIM thalamotomy.
Collapse
Affiliation(s)
- Zeiad Y Fayed
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hesham Radwan
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Aziz
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Eid
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alia H Mansour
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Nosseir
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hisham Anwer
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tarek Elserry
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Walid A Abdel Ghany
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
4
|
Ito H, Fukutake S, Yamamoto K, Yamaguchi T, Taira T, Kamei T. Magnetic Resonance Imaging-guided Focused Ultrasound Thalamotomy for Parkinson's Disease. Intern Med 2018; 57:1027-1031. [PMID: 29269662 PMCID: PMC5919866 DOI: 10.2169/internalmedicine.9586-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Thalamotomy is effective in treating refractory tremor in Parkinson's disease (PD). We herein report a PD patient who underwent left ventral intermediate nucleus and ventro oralis posterior nucleus thalamotomy using magnetic resonance imaging-guided focused ultrasound (MRgFUS). Right-side resting tremor and rigidity were abolished immediately following the ultrasound energy delivery. In addition, left-side resting tremor and rigidity also improved. No adverse events occurred during the procedure. We observed the exacerbation of bradykinesia, which might have been caused by edema around the target. This is the first report of thalamotomy using MRgFUS for PD patient from Japan. Further investigations concerning the efficacy and safety of this procedure are necessary.
Collapse
Affiliation(s)
- Hisashi Ito
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Japan
| | - Shigeru Fukutake
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Japan
| | - Kazuaki Yamamoto
- Department of Neurosurgery, Shonan Kamakura General Hospital, Japan
| | - Toshio Yamaguchi
- Research Institute of Diagnostic Imaging, Shin-Yurigaoka General Hospital, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Tetsumasa Kamei
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Japan
| |
Collapse
|
5
|
Hirato M, Miyagishima T, Takahashi A, Yoshimoto Y. Superselective Thalamotomy in the Most Lateral Part of the Ventralis Intermedius Nucleus for Controlling Essential and Parkinsonian Tremor. World Neurosurg 2018; 109:e630-e641. [DOI: 10.1016/j.wneu.2017.10.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/08/2017] [Accepted: 10/10/2017] [Indexed: 11/29/2022]
|
6
|
Stocchi F. Managing the critical problems of advanced Parkinson’s disease. Expert Rev Neurother 2014; 2:835-47. [DOI: 10.1586/14737175.2.6.835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Jourdain VA, Schechtmann G, Di Paolo T. Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action. J Neurosurg 2014; 120:140-51. [DOI: 10.3171/2013.10.jns13332] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative condition that can be pharmacologically treated with levodopa. However, important motor and nonmotor symptoms appear with its long-term use. The subthalamic nucleus (STN) is known to be involved in the pathophysiology of PD and to contribute to levodopa-induced complications. Surgery is considered in patients who have advanced PD that is refractory to pharmacotherapy and who display disabling dyskinesia. Deep brain stimulation of the STN is currently the main surgical procedure for PD, but lesioning is still performed. This review covers the clinical aspects and complications of subthalamotomy as one of the lesion-based options for PD patients with levodopa-induced dyskinesias. Moreover, the authors discuss the possible effects of subthalamic lesioning.
Collapse
Affiliation(s)
- Vincent A. Jourdain
- 1Neurosciences Research Center, Centre de Recherche du CHU de Québec
- 2Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada, and
| | - Gastón Schechtmann
- 3Department of Neurosurgery and Clinical Neuroscience, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Thérèse Di Paolo
- 1Neurosciences Research Center, Centre de Recherche du CHU de Québec
- 2Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada, and
| |
Collapse
|
8
|
Clinical features, pathophysiology, and treatment of levodopa-induced dyskinesias in Parkinson's disease. PARKINSONS DISEASE 2012; 2012:943159. [PMID: 23125942 PMCID: PMC3483732 DOI: 10.1155/2012/943159] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 08/08/2012] [Indexed: 12/29/2022]
Abstract
Dyskinetic disorders are characterized by excess of motor activity that may interfere with normal movement control. In patients with Parkinson's disease, the chronic levodopa treatment induces dyskinetic movements known as levodopa-induced dyskinesias (LID). This paper analyzed the pathophysiology, clinical manifestations, pharmacological treatments, and surgical procedures to treat hyperkinetic disorders. Surgery is currently the only treatment available for Parkinson's disease that may improve both parkinsonian motor syndrome and LID. However, this paper shows the different mechanisms involved are not well understood.
Collapse
|
9
|
|
10
|
Sankar T, Lozano AM. Surgical approach to l-dopa-induced dyskinesias. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2011; 98:151-71. [PMID: 21907086 DOI: 10.1016/b978-0-12-381328-2.00006-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Many patients treated chronically with l-dopa for Parkinson disease (PD) become functionally disabled by l-dopa-induced dyskinesias (LID). Evolved from early empirical procedures, modern stereotactic surgical lesioning techniques and deep brain stimulation (DBS) can effectively treat LID while simultaneously improving the cardinal motor symptoms of PD. Here we review the common surgical targets used to treat LID, and compare their relative efficacy. We explain the anti-dyskinetic action of surgery at each of these targets based on evolving models of basal ganglia function. Finally, we discuss the appropriate selection of patients with LID for surgery and address relevant technical and management issues in these patients.
Collapse
Affiliation(s)
- Tejas Sankar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
11
|
Anderson WS, Winberry J, Liu CC, Shi C, Lenz FA. Applying Microelectrode Recordings in Neurosurgery. CONTEMPORARY NEUROSURGERY 2010; 32:1-7. [PMID: 28316357 PMCID: PMC5350583 DOI: 10.1097/01.cne.0000369792.40458.fa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- W S Anderson
- Dept of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Winberry
- Dept of Neurosurgery, Johns Hopkins Hospital, Baltimore Maryland, USA 21287-7713
| | - C C Liu
- Dept of Neurosurgery, Johns Hopkins Hospital, Baltimore Maryland, USA 21287-7713
| | - C Shi
- Dept of Neurosurgery, Johns Hopkins Hospital, Baltimore Maryland, USA 21287-7713
| | - F A Lenz
- Dept of Neurosurgery, Johns Hopkins Hospital, Baltimore Maryland, USA 21287-7713
| |
Collapse
|
12
|
Blomstedt P, Sandvik U, Fytagoridis A, Tisch S. THE POSTERIOR SUBTHALAMIC AREA IN THE TREATMENT OF MOVEMENT DISORDERS. Neurosurgery 2009; 64:1029-38; discussion 1038-42. [DOI: 10.1227/01.neu.0000345643.69486.bc] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
THE INTRODUCTION OF thalamotomy in 1954 led naturally to exploration of the underlying subthalamic area, with the development of such procedures as campotomy and subthalamotomy in the posterior subthalamic area. The most popular of these procedures was the subthalamotomy, which was performed in thousands of patients for various movement disorders. Today, in the deep brain stimulation (DBS) era, subthalamic nucleus DBS is the treatment of choice for Parkinson's disease, whereas thalamic and pallidal DBS are mainly used for nonparkinsonian tremor and dystonia, respectively. The interest in DBS in the posterior subthalamic area has been quite limited, however, with a total of 95 patients presented in 14 articles. During recent years, interest has increased, and promising results have been published concerning both Parkinson's disease and nonparkinsonian tremor. We reviewed the literature to investigate the development of surgery in the posterior subthalamic area from the lesional era to the present.
Collapse
Affiliation(s)
- Patric Blomstedt
- Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden
| | - Ulrika Sandvik
- Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden
| | - Anders Fytagoridis
- Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden
| | - Stephen Tisch
- Department of Neurology, St. Vincent's Hospital, Sydney, Australia
| |
Collapse
|
13
|
Guridi J, Obeso JA, Rodriguez-Oroz MC, Lozano AM, Manrique M. L-DOPA-INDUCED DYSKINESIA AND STEREOTACTIC SURGERY FOR PARKINSON'S DISEASE. Neurosurgery 2008; 62:311-23; discussion 323-5. [DOI: 10.1227/01.neu.0000315998.58022.55] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
To assess the impact of different surgical targets and techniques, such as ablation and deep brain stimulation, to treat patients with L-dopa-induced dyskinesia (LID), a major therapeutic complication of Parkinson's disease.
METHODS
This review analyzes the effects of early surgical procedures to treat hyperkinesia and the current methods and targets used to combat LID in Parkinson's disease, which are mainly thalamotomy, pallidotomy, and deep brain stimulation of the globus pallidus internus and the subthalamic nucleus.
RESULTS
Available information indicates that surgery of the globus pallidus internus and thalamus (the pallidal receiving area) and of the subthalamic nucleus has a pronounced antidyskinetic effect. This effect is associated with a concomitant improvement in the parkinsonian (“off”-medication) state. Although it is more profound with pallidal and subthalamic surgery, such an effect can also be observed to some extent with thalamic surgery. The latter is attributable to the fact that surgery of the ventralis intermedius is primarily effective for treating tremor. An integral pallidothalamic pathway is needed for dyskinesia to be expressed. Thus, LID is less frequent after subthalamotomy or deep brain stimulation of the subthalamic nucleus through a functional effect mediated by the physiological normalization of the motor system and by an indirect effect associated with a reduction in the daily dose of L-dopa.
CONCLUSION
Surgery is the only treatment available for Parkinson's disease that can predictably improve both the parkinsonian motor syndrome and LID. The exact mechanisms involved in these effects are not well understood. Pallidal and thalamic surgery affecting pallidal relays reduce LID frequency by disrupting the pallidothalamic circuit, probably eliminating the neuronal activity associated with dyskinesia. Alternatively, the antidyskinetic effect of subthalamic nucleus surgery may in part be attributable to a reduction in the L-dopa dose as well as to the stabilization of the basal ganglia circuits after the surgical procedure.
Collapse
Affiliation(s)
- Jorge Guridi
- Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra, Pamplona, Spain
| | - Jose A. Obeso
- Division of Neurosurgery, Neuroscience Department, University Clinic and Neuroscience Center, University of Navarra, Pamplona, Spain
| | - Maria C. Rodriguez-Oroz
- Divisions of Neurology and Neurosurgery, University Clinic and Neuroscience Center, University of Navarra, Pamplona, Spain
| | - Andres M. Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Miguel Manrique
- Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra, Pamplona, Spain
| |
Collapse
|
14
|
|
15
|
López-Flores G, Miguel-Morales J, Teijeiro-Amador J, Vitek J, Perez-Parra S, Fernández-Melo R, Maragoto C, Alvarez E, Alvarez L, Macías R, Obeso JA. Anatomic and neurophysiological methods for the targeting and lesioning of the subthalamic nucleus: Cuban experience and review. Neurosurgery 2003; 52:817-30; discussion 831. [PMID: 12657177 DOI: 10.1227/01.neu.0000053224.16728.7d] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2002] [Accepted: 11/11/2002] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To develop a method to place a lesion precisely in the subthalamic nucleus (STN) and evaluate its effectiveness. METHODS A retrospective study of targeting data collected during stereotactic planning to lesion the STN in 31 patients with Parkinson's disease and of results in more than 50 procedures was performed. The targeting method was based on computed tomographic imaging together with semimicroelectrode recording digital processing and electrical stimulation. Two statistical methods were used to correlate initial with final target coordinates and assess the efficacy of the targeting procedure. RESULTS The anatomic target based on computed tomographic imaging data showed electrical activity in the subthalamus in the first pass in 82% of the procedures. In the remaining 18%, the STN was an average of 1.93 mm away from the nearest trajectory that recorded the STN (range, 1.41-2.24 mm). The average number of trajectories per procedure was 7.2; the location of the first trajectory relative to the center of the nucleus determined by electrical and physiological means (P < 0.01, analysis of variance, Student's t test) was as follows: in the lateral direction, 1.25 +/- 1.15 mm; in the anteroposterior direction, 1.53 +/- 1.31 mm; and in the vertical direction, 0.67 +/- 0.51 mm. The average number of tracts necessary to lesion the STN was two. CONCLUSION The combination of computed tomographic imaging, semimicroelectrode recording, and microstimulation provides an effective method to identify the STN lesion in parkinsonian patients. The method used for anatomic localization and electrophysiological mapping of the subthalamus was found to be effective in reaching the sensorimotor region of the nucleus. We carried out an accurate determination of the subthalamus location and its volume in the lesioning.
Collapse
Affiliation(s)
- Gerardo López-Flores
- Department of Neurosurgery and Motor Disorders Clinic, Centro Internacional de Restauración Neurológica, Havana, Cuba.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
Most patients with Parkinson's disease (PD) receiving chronic levodopa therapy eventually manifest one or more motor response complications, including 'wearing-off' phenomena and on-off phenomena. Additionally, as the disease progresses, motor, neurologic, and neuropsychiatric complications increase and may include freezing spells, falls, dementia, depression and psychosis. The management of patients with advanced PD presents a special clinical challenge because patients may experience an enhanced sensitivity to small changes in plasma levodopa levels and because they may suffer adverse reactions to antiparkinsonian drugs. Management of advanced PD is directed toward decreasing the dose of the offending drug while raising the dose of alternative drug with the goal of maintaining symptom control. In this article, the spectrum of late complications experienced by patients with advanced PD and their management are discussed.
Collapse
Affiliation(s)
- Cheryl H Waters
- Department of Neurology, Division of Movement Disorders, Columbia University, 710 W 168th Street, New York, NY 10032, USA
| |
Collapse
|
17
|
Pinto RASR, Borges V, Aguiar PMC, Ferraz FA, Hisatugo MKI, Ferraz HB. Avaliação das atividades da vida diária dos pacientes com doença de Parkinson submetidos a cirurgia estereotáxica. ARQUIVOS DE NEURO-PSIQUIATRIA 2002. [DOI: 10.1590/s0004-282x2002000300018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar o impacto da cirurgia estereotáxica sobre a realização das atividades da vida diária dos paciente com doença de Parkinson (DP). MÉTODO: Foram avaliados 30 pacientes com DP forma idiopática submetidos a cirurgia estereotáxica nos períodos pré-operatório, 1º, 3º, 6º e 12º mês pós-operatório, segundo as escala UPDRS - Item II (escala unificada para DP), Schwab & England e Hoehn & Yahr. Destes, nove pacientes foram também avaliados no 24º mês pós-operatório. RESULTADOS: Foram realizadas nove palidotomias póstero-ventrais (PPV), sendo duas à esquerda e sete à direita; duas PPV bilaterais no mesmo tempo cirúrgico; 17 talamotomias ventro-laterais (TVL), sendo 12 à esquerda e cinco à direita; duas TVL à esquerda com PPV à direita no mesmo tempo cirúrgico. Os escores médios, na fase off, das escalas utilizadas foram: 65,6 no pré-operatório,74 no 1º mês, 76,6 no 3º mês, 75,6 no 6º mês e 72,3 no 12º mês pós-operatório (Schwab & England); 21 no pré-operatório, 12,3 no 1º mês, 14,7 no 3º mês, 15,27 no 6º mês e 17,1 no 12º mês pós-operatório (UPDRS); 3,1 no pré-operatório, 2,8 no 1º mês, 2,7 no 3º mês, 2,8 no 6º mês e 2,85 no 12º mês pós-operatório (Hoehn & Yarh). CONCLUSÃO: A TVL e a PPV são procedimentos capazes de melhorar a independência dos pacientes para realização das atividades cotidianas, sendo constatado benefício maior nos seis primeiros meses de pós-operatório.
Collapse
|
18
|
Henselmans JM, de Jong BM, Pruim J, Staal MJ, Rutgers AW, Haaxma R. Acute effects of thalamotomy and pallidotomy on regional cerebral metabolism, evaluated by PET. Clin Neurol Neurosurg 2000; 102:84-90. [PMID: 10817894 DOI: 10.1016/s0303-8467(00)00070-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The subacute effect of thalamotomy and pallidotomy on regional cerebral metabolism was studied by means of Positron Emission Tomography (PET). In this way we aimed to identify the pattern of functional deafferentiation following a specific lesion in the basal ganglia. The cerebral distribution of 2-[18F]fluoro 2-deoxy-D-glucose (FDG) uptake at 1-2 weeks after operation was compared with the uptake before operation. Analysis of the changes was done by statistical parametric mapping (SPM). Thalamotomy resulted in a reduction of FDG uptake in predominantly the lateral prefrontal- and the parietal cortex, whereas pallidotomy affected only uptake in the (pre)frontal cortex. The absence of change in the primary sensory-motor cortex after either surgical procedure may suggest that, in man, the motor portions of the thalamus exert a predominantly indirect influence on the human motor cortex.
Collapse
Affiliation(s)
- J M Henselmans
- Department of Neurology, University Hospital Groningen, PO Box 30. 001, 9700 RB, Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|
19
|
Abstract
Stereotaxtic surgery is an effective therapeutic maneuver in the management of advanced Parkinson's disease (PD). Thalamotomy is an effective measure to control tremor but other PD symptoms are not changed. Bilateral operations are associated with a risk of severe speech impairment. Deep brain stimulation (DBS) of the thalamus is as effective as thalamotomy and is associated with fewer side effects. Pallidotomy is effective in reducing contralateral dyskinesias and the cardinal symptoms of PD. Bilateral pallidotomy often results in cognitive dysfunction. Deep brain stimulation of the pallidum replicates the positive effects of pallidotomy and appears to be safer than ablative lesions. Subthalamic DBS is currently under investigation. This procedure may control all PD symptoms, and the dose of levodopa can often be dramatically reduced. Neurotransplantation is a promising surgical approach to PD. However, further investigation is needed to optimize this approach.
Collapse
Affiliation(s)
- W C Koller
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160-7314, USA.
| | | | | | | |
Collapse
|
20
|
Abstract
The two major questions in the treatment of early PD are (1) Does selegiline slow neuronal loss and delay the progression of clinical disability? and (2) Should dopamine agonists be used as initial symptomatic therapy in early disease rather than levodopa/PDI to reduce long-term disability and delay the onset of motor fluctuations and dyskinesia? Selegiline affords neuroprotection for dopamine neurons in cell culture systems and the results of several clinical trials are consistent with the hypothesis that it is neuroprotective in Parkinson's disease. Several clinical trials have found that initial symptomatic therapy with dopamine agonist to which levodopa/carbidopa is later added when needed leads to a lower incidence of long-term motor complications. These strategies are now being tested in prospective, randomized, blinded trials, many of which include PET or SPECT scans to assess the rate of dopamine neuron loss. These trials will provide more definitive answers to guide the early medial management of Parkinson's disease in the future.
Collapse
Affiliation(s)
- R A Hauser
- Department of Neurology, Tampa General Hospital, Florida, USA
| | | |
Collapse
|
21
|
Abstract
Surgical treatments for Parkinson's disease (PD) have again become important adjuncts of care in these patients. We have learned much from the thousands of lesions performed historically, and are now advancing the entire field of movement disorder surgery to new levels of sophistication and understanding. The last 5 years have seen more precise and reliable lesioning and the arrival of multiple sites of intervention afforded by recent developments in deep brain stimulators. Because patients typically derive significant benefit in their quality of life from these procedures, while undergoing little risk, the surgical options should be carefully considered for selected PD patients.
Collapse
Affiliation(s)
- J E Arle
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, USA
| | | |
Collapse
|
22
|
Ferraz FP, Aguiar PM, Ferraz HB, Bidó JO, Bouza AA, De Andrade LA. [Stereotaxic thalamotomy and pallidotomy with computerized planning in Parkinson's disease: short-term evaluation of motor function in 50 patients]. ARQUIVOS DE NEURO-PSIQUIATRIA 1998; 56:789-97. [PMID: 10029883 DOI: 10.1590/s0004-282x1998000500014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We evaluated the motor function of 50 patients with Parkinson's disease, who underwent stereotaxic surgery with computerized planning, without ventriculography (ventrolateral thalamotomy- VLT- and/or posteroventral pallidotomy- PVP) before and one month after surgery. 27 unilateral TVL, 10 unilateral PVP, 6 bilateral PVP, and 7 TVL with PVP were performed. The motor evaluation was performed with the Unified Parkinson's Disease Rating Scale, motor score, during on and off periods. We observed a global motor improvement in all groups. The improvement of dyskinesias was obtained in the contralateral side of the body, in the PVP groups. From the 50 patients, 16 (32%) presented post-operative complications, 9 of these (56.25%) improved completely, 6 (37.25%) improved partially, and 1 (6.25%) did not improve during the first month. These results were considered satisfactory, and a long term analysis will show whether these benefits are long lasting or not.
Collapse
Affiliation(s)
- F P Ferraz
- Universidade Federal de São Paulo (UNIFESP)-Escola Paulista de Medicina (EPM), Brasil
| | | | | | | | | | | |
Collapse
|
23
|
Starr PA, Vitek JL, Bakay RA. Ablative surgery and deep brain stimulation for Parkinson's disease. Neurosurgery 1998; 43:989-1013; discussion 1013-5. [PMID: 9802843 DOI: 10.1097/00006123-199811000-00001] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Surgical options for Parkinson's disease (PD) are rapidly expanding and include ablative procedures, deep brain stimulation, and cell transplantation. The target nuclei for ablative surgery and deep brain stimulation are the motor thalamus, the globus pallidus, and the subthalamic nucleus. Multiple factors have led to the resurgence of interest in the surgical treatment of PD: 1) recognition that long-term medical therapy for PD is often unsatisfactory, with patients eventually suffering from drug-induced dyskinesias, motor fluctuations, and variable responses to medication; 2) greater understanding of the pathophysiology of PD, providing a better scientific rationale for some previously developed procedures and suggesting new targets; and 3) use of improved techniques, such as computed tomography- and magnetic resonance imaging-guided stereotaxy and single-unit microelectrode recording, making surgical intervention in the basal ganglia more precise. We review the present status of ablative surgery and deep brain stimulation for PD, including theoretical aspects, surgical techniques, and clinical results.
Collapse
Affiliation(s)
- P A Starr
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | | |
Collapse
|
24
|
Koller WC, Wilkinson S, Pahwa R, Miyawaki EK. Surgical Treatment Options in Parkinson's Disease. Neurosurg Clin N Am 1998. [DOI: 10.1016/s1042-3680(18)30265-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
25
|
|
26
|
|
27
|
Johansson F, Malm J, Nordh E, Hariz M. Usefulness of pallidotomy in advanced Parkinson's disease. J Neurol Neurosurg Psychiatry 1997; 62:125-32. [PMID: 9048711 PMCID: PMC486722 DOI: 10.1136/jnnp.62.2.125] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The combined effect of posteroventral pallidotomy and optimal medical treatment was assessed in 22 patients with levodopa sensitive Parkinson's disease. METHODS Timed motor tests, video recordings, and computer assisted optoelectronic movement analysis were used for serial hourly assessments performed preoperatively and four and 12 months after operation. Tests were made while patients were on optimal medical therapy. RESULTS There were no serious adverse events of surgery. Two of the 22 patients could not complete all the tests after operation. The proportion of dyskinesia periods decreased in the 20 patients and there was a proportional increase in normal or fairly normal occasions. "Off" periods were not significantly affected. In 12 of 13 patients with limb dyskinesia this symptom was completely abolished in the contralateral limbs. There was also some degree of improvement axially and ipsilaterally. Tremor was moderately improved contralaterally. Bradykinesia remained unchanged. Results at 12 months follow up were similar to those at four months. CONCLUSION Pallidotomy produced a pronounced positive effect on dyskinesia and a moderate effect on tremor. Bradykinesia was not affected. Posteroventral pallidotomy may be useful in patients with Parkinson's disease who have severe motor fluctuations and may allow an increase in levodopa dose to alleviate bradykinesia in "off" states.
Collapse
Affiliation(s)
- F Johansson
- Department of Neurology, University Hospital of Northern Sweden, Umeå, Sweden
| | | | | | | |
Collapse
|
28
|
Favre J, Taha JM, Nguyen TT, Gildenberg PL, Burchiel KJ. Pallidotomy: a survey of current practice in North America. Neurosurgery 1996; 39:883-90; discussion 890-2. [PMID: 8880789 DOI: 10.1097/00006123-199610000-00060] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Twenty-eight centers completed a survey about their current practice of pallidotomy. This sample represents a non-exhaustive survey of the current practice of pallidotomy in North America and is not a study of outcomes. 1015 patients underwent 1219 pallidotomies: 811 (80%) unilateral, 72 (7%) staged bilateral, and 132 (13%) simultaneous bilateral. Pallidotomy has long been an accepted procedure and the indications for this surgery, in the opinion of the responding centers, were rated on a scale of 1 (poor) to 4 (excellent) and demonstrated dyskinesia as the best indication (median = 4); on-off fluctuations, dystonia, rigidity, and bradykinesia as good indications (median = 3); and freezing, tremor and gait disturbance as fair indications (median = 2). Most centers used MRI alone (50%) or in combination with CT scan (n = 6) or ventriculopathy (n = 5) to localize the target. The median values of pallidal coordinates were: 2 mm anterior to the midcommissural point 21 mm lateral to the midsagittal plane and 5 mm below the intercommissural line. Microrecording was performed by half of the centers (n = 14) and half of the remaining centers were considering starting it (n = 7). Main criteria used to define the target included the firing pattern of spontaneous neuronal discharges (n = 13) and the response to joint movement (n = 10). Most centers performed motor (n = 26) and visual (n = 23) macrostimulation. Twenty four centers performed test lesions using median values of 55 degrees C temperatures for 30 s. Final lesions consisted of 3 permanent lesions placed 2 mm apart, each lesion created with median values of 75 degrees C temperatures for 1 minute. Median hospital stay was 2 days.
Collapse
Affiliation(s)
- J Favre
- Division of Neurosurgery, Oregon Health Sciences University, Portland, USA
| | | | | | | | | |
Collapse
|
29
|
Goetz CG, Diederich NJ. There is a renaissance of interest in pallidotomy for Parkinson's disease. Nat Med 1996; 2:510-4. [PMID: 8616702 DOI: 10.1038/nm0596-510] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- C G Goetz
- Department of Neurological Sciences, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois 60612, USA
| | | |
Collapse
|
30
|
Lukhanina EP. Role of the ventrolateral nucleus of the thalamus in extrapyramidal motor pathology. NEUROPHYSIOLOGY+ 1996. [DOI: 10.1007/bf01053340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
31
|
Alterman RL, Kall BA, Cohen H, Kelly PJ. Stereotactic ventrolateral thalamotomy: is ventriculography necessary? Neurosurgery 1995; 37:717-21; discussion 721-2. [PMID: 8559301 DOI: 10.1227/00006123-199510000-00016] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
In the computed tomography/magnetic resonance imaging (CT/MRI) era, the need for ventriculography to perform ventrolateral thalamotomy accurately has been debated. We retrospectively compared CT/MRI-derived coordinates for ventrolateral thalamotomy with the final lesion coordinates that were determined by ventriculography and microelectrode recording in 74 thalamotomies performed from 1984 to 1994. The median three-dimensional distance between the CT/MRI-derived loci and the ventriculography/microelectrode loci was 4.7 mm (range, 1.0-11.7 mm). The techniques correlated least along the Y axis (median, -0.3 mm; range, -8.2 to 8.0 mm). Correlation along the X axis was most consistent (median, 0.5 mm; range, -4.2 to 5.0 mm). Since 1990, the CT/MRI-derived coordinates have been generated by a multimodality correlative imaging technique (MCIT). A comparison of thalamotomies performed with and without the MCIT revealed a significant improvement in the correlation of CT/MRI- and ventriculography/microelectrode-derived coordinates when the MCIT was employed. The greatest improvement was noted along the Y axis where the median absolute difference was reduced from 4.0 to 1.8 mm (P = 0.0001). The result was a statistically significant reduction in the median three-dimensional distance from 5.6 to 3.7 mm (P = 0.0007). The authors conclude that thalamotomies can be safely and effectively performed without ventriculography when the MCIT is employed and supported by neurophysiological monitoring.
Collapse
Affiliation(s)
- R L Alterman
- Department of Neurological Surgery, New York University Medical Center, New York, USA
| | | | | | | |
Collapse
|
32
|
|
33
|
Outcome after Stereotactic Thalamotomy for Parkinsonian, Essential, and Other Types of Tremor. Neurosurgery 1995. [DOI: 10.1097/00006123-199510000-00011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
34
|
Jankovic J, Cardoso F, Grossman RG, Hamilton WJ. Outcome after stereotactic thalamotomy for parkinsonian, essential, and other types of tremor. Neurosurgery 1995; 37:680-6; discussion 686-7. [PMID: 8559296 DOI: 10.1227/00006123-199510000-00011] [Citation(s) in RCA: 194] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A better understanding of the mechanisms underlying movement disorders, coupled with refinements in surgical technique, has led to a resurgence of interest in the surgical treatment of patients with tremor. We retrospectively analyzed the outcomes of 60 patients (62 patient sides) with medically intractable tremor who underwent stereotactic thalamotomy. Of these 60 patients, 42 had Parkinson's disease (of whom 2 patients underwent bilateral surgery for a total of 44 patient sides), 6 had essential tremor, 6 had cerebellar tremor, and 6 had post-traumatic tremor. The patients received follow-up for as long as 13 years (mean, 53.4 mo) after their operations. At the most recent follow-up visit, 86% of the patients with Parkinson's disease, 83% of the patients with essential tremor, 67% of the patients with cerebellar tremor, and 50% of the patients with post-traumatic tremor had cessation of or moderate-to-marked improvement in their contralateral tremor, with a concomitant improvement in function. The mean daily dose of levodopa for those patients preoperatively taking levodopa (n = 35) was reduced by approximately 156 mg at a mean of 53.4 months after thalamotomy. Immediate postoperative complications were common, occurring in 58% of patients. The most common complications were contralateral weakness (34%), dysarthria (29%), and confusion (23%). These complications generally resolved rapidly during the postoperative period.
Collapse
Affiliation(s)
- J Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | |
Collapse
|
35
|
Abstract
Writer's cramp is frequently associated with hand tremor and with other focal dystonias. Sometimes brain infarction, haemorrhage, arterio-venous malformations or tumors are found to cause symptomatic focal dystonias. A 44-year-old man came to our attention due to writer's cramp of his right hand and postural 6-8 Hz tremor. About three months after the onset of the disease the tremor and dystonia disappeared, while a right hemiparesis gradually appeared. Cranial computed tomography showed a hypodense nonhomogeneous lesion in the left cerebral hemisphere parietally, that was assumed to represent a cystic tumor. The patient underwent craniotomy and the histological diagnosis revealed an astrocytoma (Grade II-III). In conclusion our findings confirm the common anatomical basis of symptomatic focal dystonia and tremor. Both can appear after disruption of the pathways within and adjacent to the basal ganglia.
Collapse
Affiliation(s)
- I Milanov
- Medical University Hospital, III Neurological Clinic, Sofia, Bulgaria
| | | |
Collapse
|
36
|
Tang LC. Perspective of neurochemistry in neurological disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1995; 363:1-13. [PMID: 7542429 DOI: 10.1007/978-1-4615-1857-0_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- L C Tang
- Department of Experimental Therapeutics, Walter Reed Army Institute of Research, Washington, DC 20307, USA
| |
Collapse
|
37
|
Parent A, Hazrati LN. Functional anatomy of the basal ganglia. II. The place of subthalamic nucleus and external pallidum in basal ganglia circuitry. BRAIN RESEARCH. BRAIN RESEARCH REVIEWS 1995; 20:128-154. [PMID: 7711765 DOI: 10.1016/0165-0173(94)00008-d] [Citation(s) in RCA: 955] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The subthalamic nucleus and the external pallidum (GPe) are classically viewed as part of the so-called indirect pathway, which acts in concert with the direct pathway. The direct and indirect pathways form the conceptual framework of the anatomical and functional organization of the basal ganglia. A review of recent data regarding the connections of the subthalamic nucleus and the GPe has revealed a lack of firm anatomical support for the existence of the indirect pathway. However, newly recognized projections of the subthalamic nucleus and the GPe place these structures on various novel routes that change the conceptual architecture of the basal ganglia circuitry. These new findings force us to modify our view of the functional identity of the subthalamic nucleus and the GPe. In this new perspective, the GPe stands as an additional integrative station, together with the striatum and the internal pallidum and substantia nigra pars reticulata (GPi/SNr), along the main steam of information processing within the basal ganglia circuitry. Because of its crucial position between the input and output stations of the basal ganglia, the GPe can markedly influence the neuronal computation that occurs at GPi/SNr levels. The subthalamic nucleus can still be regarded as a 'control structure' lying alongside the main stream of information processing. However, because of its widespread efferent projections, the subthalamic nucleus exerts its driving effect on most components of the basal ganglia. Its action is mediated not only by the indirect pathway, but by a multitude of mono- and polysynaptic projections that ultimately reach the basal ganglia output cells.
Collapse
Affiliation(s)
- A Parent
- Centre de recherche en neurobiologie, Hôpital de l'Enfant-Jésus, Québec, QC, Canada
| | | |
Collapse
|
38
|
Affiliation(s)
- C D Marsden
- University Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery London UK
| |
Collapse
|
39
|
Grafton ST, Sutton J, Couldwell W, Lew M, Waters C. Network analysis of motor system connectivity in Parkinson's disease: Modulation of thalamocortical interactions after pallidotomy. Hum Brain Mapp 1994. [DOI: 10.1002/hbm.460020106] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
40
|
Guridi J, Luquin MR, Herrero MT, Obeso JA. The subthalamic nucleus: a possible target for stereotaxic surgery in Parkinson's disease. Mov Disord 1993; 8:421-9. [PMID: 8232351 DOI: 10.1002/mds.870080402] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Hyperactivity in the subthalamic nucleus (STN) projections to the globus pallidus medialis (GPM) has been established as a crucial feature of parkinsonism in animal models of Parkinson's disease (PD). Recent experiments blocking the STN glutamatergic output to GPM or lesioning the STN support this concept by showing a dramatic reversal of parkinsonism. We review the role of stereotaxic surgery in the past and the possible future application of subthalamotomy for PD.
Collapse
Affiliation(s)
- J Guridi
- Movement Disorders Unit, Clinica Universitaria, Pamplona, Spain
| | | | | | | |
Collapse
|