Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease
Identifieur interne : 002A66 ( Istex/Corpus ); précédent : 002A65; suivant : 002A67Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease
Auteurs : Robert E. Gross ; Wendy J. Lombardi ; Anthony E. Lang ; Jan Duff ; William D. Hutchison ; Jean A. Saint-Cyr ; Ronald R. Tasker ; Andres M. LozanoSource :
- Brain [ 0006-8950 ] ; 1999-03.
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Abstract
The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative `off' period, and in `on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in `off' period contralateral rigidity and `on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.
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DOI: 10.1093/brain/122.3.405
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Lang</name><affiliation><mods:affiliation>Movement Disorders Centre, The Toronto Hospital,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Duff, Jan" sort="Duff, Jan" uniqKey="Duff J" first="Jan" last="Duff">Jan Duff</name><affiliation><mods:affiliation>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Hutchison, William D" sort="Hutchison, William D" uniqKey="Hutchison W" first="William D." last="Hutchison">William D. 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Lozano</name><affiliation><mods:affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:4D01AE3918DE153E9C542F7C713A50DD95E26B5C</idno><date when="1999" year="1999">1999</date><idno type="doi">10.1093/brain/122.3.405</idno><idno type="url">https://api-v5.istex.fr/document/4D01AE3918DE153E9C542F7C713A50DD95E26B5C/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002A66</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">002A66</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</title><author><name sortKey="Gross, Robert E" sort="Gross, Robert E" uniqKey="Gross R" first="Robert E." last="Gross">Robert E. Gross</name><affiliation><mods:affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Lombardi, Wendy J" sort="Lombardi, Wendy J" uniqKey="Lombardi W" first="Wendy J." last="Lombardi">Wendy J. Lombardi</name><affiliation><mods:affiliation>Department of Psychology,</mods:affiliation></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name><affiliation><mods:affiliation>Movement Disorders Centre, The Toronto Hospital,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Duff, Jan" sort="Duff, Jan" uniqKey="Duff J" first="Jan" last="Duff">Jan Duff</name><affiliation><mods:affiliation>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Hutchison, William D" sort="Hutchison, William D" uniqKey="Hutchison W" first="William D." last="Hutchison">William D. Hutchison</name><affiliation><mods:affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Saint Cyr, Jean A" sort="Saint Cyr, Jean A" uniqKey="Saint Cyr J" first="Jean A." last="Saint-Cyr">Jean A. Saint-Cyr</name><affiliation><mods:affiliation>Department of Psychology,</mods:affiliation></affiliation><affiliation><mods:affiliation>Departments of Anatomy and Cell Biology and of Psychology, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Tasker, Ronald R" sort="Tasker, Ronald R" uniqKey="Tasker R" first="Ronald R." last="Tasker">Ronald R. Tasker</name><affiliation><mods:affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation><mods:affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Brain</title><title level="j" type="abbrev">Brain</title><idno type="ISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="1999-03">1999-03</date><biblScope unit="volume">122</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="405">405</biblScope><biblScope unit="page" to="416">416</biblScope></imprint><idno type="ISSN">0006-8950</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>GPe = globus pallidus externus</term><term>GPi = globus pallidus internus</term><term>Parkinson's disease</term><term>UPDRS = Unified Parkinson's Disease Rating Scale</term><term>clinical outcome</term><term>globus pallidus</term><term>pallidotomy</term><term>vMRI = volumetric MRI</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative `off' period, and in `on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in `off' period contralateral rigidity and `on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Robert E. Gross</name><affiliations><json:string>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</json:string></affiliations></json:item><json:item><name>Wendy J. Lombardi</name><affiliations><json:string>Department of Psychology,</json:string></affiliations></json:item><json:item><name>Anthony E. Lang</name><affiliations><json:string>Movement Disorders Centre, The Toronto Hospital,</json:string><json:string>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</json:string></affiliations></json:item><json:item><name>Jan Duff</name><affiliations><json:string>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</json:string></affiliations></json:item><json:item><name>William D. Hutchison</name><affiliations><json:string>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</json:string></affiliations></json:item><json:item><name>Jean A. Saint-Cyr</name><affiliations><json:string>Department of Psychology,</json:string><json:string>Departments of Anatomy and Cell Biology and of Psychology, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Ronald R. Tasker</name><affiliations><json:string>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</json:string></affiliations></json:item><json:item><name>Andres M. Lozano</name><affiliations><json:string>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>globus pallidus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>pallidotomy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>clinical outcome</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>GPe = globus pallidus externus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>GPi = globus pallidus internus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>UPDRS = Unified Parkinson's Disease Rating Scale</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>vMRI = volumetric MRI</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative `off' period, and in `on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in `off' period contralateral rigidity and `on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.</abstract><qualityIndicators><score>10</score><pdfWordCount>6096</pdfWordCount><pdfCharCount>42645</pdfCharCount><pdfVersion>1.1</pdfVersion><pdfPageCount>12</pdfPageCount><pdfPageSize>595 x 842 pts (A4)</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>260</abstractWordCount><abstractCharCount>1950</abstractCharCount><keywordCount>8</keywordCount></qualityIndicators><title>Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</title><genre><json:string>research-article</json:string></genre><host><title>Brain</title><language><json:string>unknown</json:string></language><issn><json:string>0006-8950</json:string></issn><eissn><json:string>1460-2156</json:string></eissn><publisherId><json:string>brainj</json:string></publisherId><volume>122</volume><issue>3</issue><pages><first>405</first><last>416</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>neurosciences</json:string><json:string>clinical neurology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>neurology & neurosurgery</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>1999</publicationDate><copyrightDate>1999</copyrightDate><doi><json:string>10.1093/brain/122.3.405</json:string></doi><id>4D01AE3918DE153E9C542F7C713A50DD95E26B5C</id><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api-v5.istex.fr/document/4D01AE3918DE153E9C542F7C713A50DD95E26B5C/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api-v5.istex.fr/document/4D01AE3918DE153E9C542F7C713A50DD95E26B5C/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api-v5.istex.fr/document/4D01AE3918DE153E9C542F7C713A50DD95E26B5C/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>© Oxford University Press 1999</p></availability><date>1999</date></publicationStmt><notesStmt><note>Dr R. E. Gross, Division of Neurosurgery, The Toronto Hospital, Western Division, 399 Bathurst Street, McL 2-433, Toronto, Ontario, Canada M5T 2S8</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</title><author xml:id="author-0000"><persName><forename type="first">Robert E.</forename><surname>Gross</surname></persName><affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Wendy J.</forename><surname>Lombardi</surname></persName><affiliation>Department of Psychology,</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Anthony E.</forename><surname>Lang</surname></persName><affiliation>Movement Disorders Centre, The Toronto Hospital,</affiliation><affiliation>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Jan</forename><surname>Duff</surname></persName><affiliation>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</affiliation></author><author xml:id="author-0004"><persName><forename type="first">William D.</forename><surname>Hutchison</surname></persName><affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Jean A.</forename><surname>Saint-Cyr</surname></persName><affiliation>Department of Psychology,</affiliation><affiliation>Departments of Anatomy and Cell Biology and of Psychology, University of Toronto, Toronto, Ontario, Canada</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Ronald R.</forename><surname>Tasker</surname></persName><affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</affiliation></author><author xml:id="author-0007"><persName><forename type="first">Andres M.</forename><surname>Lozano</surname></persName><affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</affiliation></author><idno type="istex">4D01AE3918DE153E9C542F7C713A50DD95E26B5C</idno><idno type="DOI">10.1093/brain/122.3.405</idno><idno type="local">1220405</idno></analytic><monogr><title level="j">Brain</title><title level="j" type="abbrev">Brain</title><idno type="pISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><idno type="PublisherID">brainj</idno><idno type="PublisherID-hwp">brain</idno><idno type="PublisherID-nlm-ta">Brain</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="1999-03"></date><biblScope unit="volume">122</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="405">405</biblScope><biblScope unit="page" to="416">416</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1999</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative `off' period, and in `on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in `off' period contralateral rigidity and `on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>Parkinson's disease</term></item><item><term>globus pallidus</term></item><item><term>pallidotomy</term></item><item><term>clinical outcome</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>ABR</head><item><term>GPe = globus pallidus externus</term></item><item><term>GPi = globus pallidus internus</term></item><item><term>UPDRS = Unified Parkinson's Disease Rating Scale</term></item><item><term>vMRI = volumetric MRI</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1999-03">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api-v5.istex.fr/document/4D01AE3918DE153E9C542F7C713A50DD95E26B5C/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="US-ASCII"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">brain</journal-id><journal-id journal-id-type="nlm-ta">Brain</journal-id><journal-id journal-id-type="publisher-id">brainj</journal-id><journal-title>Brain</journal-title><abbrev-journal-title abbrev-type="publisher">Brain</abbrev-journal-title><issn pub-type="ppub">0006-8950</issn><issn pub-type="epub">1460-2156</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">1220405</article-id><article-id pub-id-type="doi">10.1093/brain/122.3.405</article-id><title-group><article-title>Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Gross</surname><given-names>Robert E.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lombardi</surname><given-names>Wendy J.</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Lang</surname><given-names>Anthony E.</given-names></name><xref rid="AFF3">3</xref><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Duff</surname><given-names>Jan</given-names></name><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Hutchison</surname><given-names>William D.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Saint-Cyr</surname><given-names>Jean A.</given-names></name><xref rid="AFF2">2</xref><xref rid="AFF5">5</xref></contrib><contrib contrib-type="author"><name><surname>Tasker</surname><given-names>Ronald R.</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lozano</surname><given-names>Andres M.</given-names></name><xref rid="AFF1">1</xref></contrib><aff id="AFF1"><label>1</label>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital, </aff><aff id="AFF2"><label>2</label>Department of Psychology, </aff><aff id="AFF3"><label>3</label>Movement Disorders Centre, The Toronto Hospital, </aff><aff id="AFF4"><label>4</label>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital, </aff><aff id="AFF5"><label>5</label>Departments of Anatomy and Cell Biology and of Psychology, University of Toronto, Toronto, Ontario, Canada</aff></contrib-group><author-notes><corresp>Dr R. E. Gross, Division of Neurosurgery, The Toronto Hospital, Western Division, 399 Bathurst Street, McL 2-433, Toronto, Ontario, Canada M5T 2S8</corresp></author-notes><pub-date pub-type="ppub"><month>3</month><year>1999</year></pub-date><volume>122</volume><issue>3</issue><fpage>405</fpage><lpage>416</lpage><history><date date-type="accepted"><day>23</day><month>10</month><year>1998</year></date><date date-type="received"><day>01</day><month>06</month><year>1998</year></date><date date-type="rev-recd"><day>30</day><month>09</month><year>1998</year></date></history><copyright-statement>© Oxford University Press 1999</copyright-statement><copyright-year>1999</copyright-year><abstract xml:lang="en"><p>The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative `off' period, and in `on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in `off' period contralateral rigidity and `on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.</p></abstract><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>Parkinson's disease</kwd><kwd>globus pallidus</kwd><kwd>pallidotomy</kwd><kwd>clinical outcome</kwd></kwd-group><kwd-group kwd-group-type="ABR" xml:lang="en"><kwd>GPe = globus pallidus externus</kwd><kwd>GPi = globus pallidus internus</kwd><kwd>UPDRS = Unified Parkinson's Disease Rating Scale</kwd><kwd>vMRI = volumetric MRI</kwd></kwd-group><custom-meta-wrap><custom-meta><meta-name>hwp-legacy-fpage</meta-name><meta-value>405</meta-value></custom-meta><custom-meta><meta-name>hwp-legacy-dochead</meta-name><meta-value>Article</meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">Robert E.</namePart><namePart type="family">Gross</namePart><affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Wendy J.</namePart><namePart type="family">Lombardi</namePart><affiliation>Department of Psychology,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anthony E.</namePart><namePart type="family">Lang</namePart><affiliation>Movement Disorders Centre, The Toronto Hospital,</affiliation><affiliation>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jan</namePart><namePart type="family">Duff</namePart><affiliation>Department of Medicine, University of Toronto, Division of Neurology, The Toronto Hospital,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">William D.</namePart><namePart type="family">Hutchison</namePart><affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jean A.</namePart><namePart type="family">Saint-Cyr</namePart><affiliation>Department of Psychology,</affiliation><affiliation>Departments of Anatomy and Cell Biology and of Psychology, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ronald R.</namePart><namePart type="family">Tasker</namePart><affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Andres M.</namePart><namePart type="family">Lozano</namePart><affiliation>Department of Surgery, University of Toronto, Division of Neurosurgery, The Toronto Hospital,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">1999-03</dateIssued><copyrightDate encoding="w3cdtf">1999</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative `off' period, and in `on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in `off' period contralateral rigidity and `on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.</abstract><note type="author-notes">Dr R. E. Gross, Division of Neurosurgery, The Toronto Hospital, Western Division, 399 Bathurst Street, McL 2-433, Toronto, Ontario, Canada M5T 2S8</note><subject lang="en"><genre>KWD</genre><topic>Parkinson's disease</topic><topic>globus pallidus</topic><topic>pallidotomy</topic><topic>clinical outcome</topic></subject><subject lang="en"><genre>ABR</genre><topic>GPe = globus pallidus externus</topic><topic>GPi = globus pallidus internus</topic><topic>UPDRS = Unified Parkinson's Disease Rating Scale</topic><topic>vMRI = volumetric MRI</topic></subject><relatedItem type="host"><titleInfo><title>Brain</title></titleInfo><titleInfo type="abbreviated"><title>Brain</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0006-8950</identifier><identifier type="eISSN">1460-2156</identifier><identifier type="PublisherID">brainj</identifier><identifier type="PublisherID-hwp">brain</identifier><identifier type="PublisherID-nlm-ta">Brain</identifier><part><date>1999</date><detail type="volume"><caption>vol.</caption><number>122</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>405</start><end>416</end></extent></part></relatedItem><identifier type="istex">4D01AE3918DE153E9C542F7C713A50DD95E26B5C</identifier><identifier type="DOI">10.1093/brain/122.3.405</identifier><identifier type="local">1220405</identifier><accessCondition type="use and reproduction" contentType="copyright">© Oxford University Press 1999</accessCondition><recordInfo><recordContentSource>OUP</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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