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.
English descriptors
- KwdEn :
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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<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>
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<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>
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<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>
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<name type="personal"><namePart type="given">Wendy J.</namePart>
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<affiliation>Department of Psychology,</affiliation>
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<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>
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<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>
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<name type="personal"><namePart type="given">William D.</namePart>
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<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>
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<name type="personal"><namePart type="given">Ronald R.</namePart>
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<role><roleTerm type="text">author</roleTerm>
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<name type="personal"><namePart type="given">Andres M.</namePart>
<namePart type="family">Lozano</namePart>
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<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>
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<titleInfo type="abbreviated"><title>Brain</title>
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<identifier type="ISSN">0006-8950</identifier>
<identifier type="eISSN">1460-2156</identifier>
<identifier type="PublisherID">brainj</identifier>
<identifier type="PublisherID-hwp">brain</identifier>
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<part><date>1999</date>
<detail type="volume"><caption>vol.</caption>
<number>122</number>
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<detail type="issue"><caption>no.</caption>
<number>3</number>
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