L-DOPA-INDUCED DYSKINESIA AND STEREOTACTIC SURGERY FOR PARKINSON'S DISEASE. Commentaries
Identifieur interne : 002395 ( Main/Exploration ); précédent : 002394; suivant : 002396L-DOPA-INDUCED DYSKINESIA AND STEREOTACTIC SURGERY FOR PARKINSON'S DISEASE. Commentaries
Auteurs : Jorge Guridi [Espagne] ; Jose A. Obeso [Espagne] ; Maria C. Rodriguez-Oroz [Espagne] ; Andres A. Lozano [Canada] ; Miguel Manrique [Espagne] ; Philip A. Starr ; Julie G. Pilitsis ; Roy A. E. Bakay ; Marwan I. Hariz ; Ventura Arjona ; Jose G. Martin-RodriguezSource :
- Neurosurgery [ 0148-396X ] ; 2008.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Chirurgie.
English descriptors
- KwdEn :
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 hyper-kinesia 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.
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">L-DOPA-INDUCED DYSKINESIA AND STEREOTACTIC SURGERY FOR PARKINSON'S DISEASE. Commentaries</title><author><name sortKey="Guridi, Jorge" sort="Guridi, Jorge" uniqKey="Guridi J" first="Jorge" last="Guridi">Jorge Guridi</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra</s1><s2>Pamplona</s2><s3>ESP</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Obeso, Jose A" sort="Obeso, Jose A" uniqKey="Obeso J" first="Jose A." last="Obeso">Jose A. Obeso</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra</s1><s2>Pamplona</s2><s3>ESP</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Rodriguez Oroz, Maria C" sort="Rodriguez Oroz, Maria C" uniqKey="Rodriguez Oroz M" first="Maria C." last="Rodriguez-Oroz">Maria C. Rodriguez-Oroz</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra</s1><s2>Pamplona</s2><s3>ESP</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Lozano, Andres A" sort="Lozano, Andres A" uniqKey="Lozano A" first="Andres A." last="Lozano">Andres A. Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Division of Neurosurgery, Toronto Western Hospital, University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Manrique, Miguel" sort="Manrique, Miguel" uniqKey="Manrique M" first="Miguel" last="Manrique">Miguel Manrique</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra</s1><s2>Pamplona</s2><s3>ESP</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Starr, Philip A" sort="Starr, Philip A" uniqKey="Starr P" first="Philip A." last="Starr">Philip A. Starr</name></author><author><name sortKey="Pilitsis, Julie G" sort="Pilitsis, Julie G" uniqKey="Pilitsis J" first="Julie G." last="Pilitsis">Julie G. Pilitsis</name></author><author><name sortKey="Bakay, Roy A E" sort="Bakay, Roy A E" uniqKey="Bakay R" first="Roy A. E." last="Bakay">Roy A. E. Bakay</name></author><author><name sortKey="Hariz, Marwan I" sort="Hariz, Marwan I" uniqKey="Hariz M" first="Marwan I." last="Hariz">Marwan I. Hariz</name></author><author><name sortKey="Arjona, Ventura" sort="Arjona, Ventura" uniqKey="Arjona V" first="Ventura" last="Arjona">Ventura Arjona</name></author><author><name sortKey="Martin Rodriguez, Jose G" sort="Martin Rodriguez, Jose G" uniqKey="Martin Rodriguez J" first="Jose G." last="Martin-Rodriguez">Jose G. Martin-Rodriguez</name></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">08-0207896</idno><date when="2008">2008</date><idno type="stanalyst">PASCAL 08-0207896 INIST</idno><idno type="RBID">Pascal:08-0207896</idno><idno type="wicri:Area/PascalFrancis/Corpus">000656</idno><idno type="wicri:Area/PascalFrancis/Curation">000654</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000537</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000537</idno><idno type="wicri:doubleKey">0148-396X:2008:Guridi J:l:dopa:induced</idno><idno type="wicri:Area/Main/Merge">002598</idno><idno type="wicri:Area/Main/Curation">002395</idno><idno type="wicri:Area/Main/Exploration">002395</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">L-DOPA-INDUCED DYSKINESIA AND STEREOTACTIC SURGERY FOR PARKINSON'S DISEASE. Commentaries</title><author><name sortKey="Guridi, Jorge" sort="Guridi, Jorge" uniqKey="Guridi J" first="Jorge" last="Guridi">Jorge Guridi</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra</s1><s2>Pamplona</s2><s3>ESP</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Obeso, Jose A" sort="Obeso, Jose A" uniqKey="Obeso J" first="Jose A." last="Obeso">Jose A. Obeso</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra</s1><s2>Pamplona</s2><s3>ESP</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Rodriguez Oroz, Maria C" sort="Rodriguez Oroz, Maria C" uniqKey="Rodriguez Oroz M" first="Maria C." last="Rodriguez-Oroz">Maria C. Rodriguez-Oroz</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra</s1><s2>Pamplona</s2><s3>ESP</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Lozano, Andres A" sort="Lozano, Andres A" uniqKey="Lozano A" first="Andres A." last="Lozano">Andres A. Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Division of Neurosurgery, Toronto Western Hospital, University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Manrique, Miguel" sort="Manrique, Miguel" uniqKey="Manrique M" first="Miguel" last="Manrique">Miguel Manrique</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra</s1><s2>Pamplona</s2><s3>ESP</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Starr, Philip A" sort="Starr, Philip A" uniqKey="Starr P" first="Philip A." last="Starr">Philip A. Starr</name></author><author><name sortKey="Pilitsis, Julie G" sort="Pilitsis, Julie G" uniqKey="Pilitsis J" first="Julie G." last="Pilitsis">Julie G. Pilitsis</name></author><author><name sortKey="Bakay, Roy A E" sort="Bakay, Roy A E" uniqKey="Bakay R" first="Roy A. E." last="Bakay">Roy A. E. Bakay</name></author><author><name sortKey="Hariz, Marwan I" sort="Hariz, Marwan I" uniqKey="Hariz M" first="Marwan I." last="Hariz">Marwan I. Hariz</name></author><author><name sortKey="Arjona, Ventura" sort="Arjona, Ventura" uniqKey="Arjona V" first="Ventura" last="Arjona">Ventura Arjona</name></author><author><name sortKey="Martin Rodriguez, Jose G" sort="Martin Rodriguez, Jose G" uniqKey="Martin Rodriguez J" first="Jose G." last="Martin-Rodriguez">Jose G. Martin-Rodriguez</name></author></analytic><series><title level="j" type="main">Neurosurgery</title><title level="j" type="abbreviated">Neurosurgery</title><idno type="ISSN">0148-396X</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Neurosurgery</title><title level="j" type="abbreviated">Neurosurgery</title><idno type="ISSN">0148-396X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Dopa</term><term>Dyskinesia</term><term>Encephalon</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Stereotaxia</term><term>Subthalamic nucleus</term><term>Surgery</term><term>Thalamotomy</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Dyskinésie</term><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Dopa</term><term>Stéréotaxie</term><term>Chirurgie</term><term>Encéphale</term><term>Noyau sousthalamique</term><term>Thalamotomie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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 hyper-kinesia 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.</div></front></TEI><affiliations><list><country><li>Canada</li><li>Espagne</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><noCountry><name sortKey="Arjona, Ventura" sort="Arjona, Ventura" uniqKey="Arjona V" first="Ventura" last="Arjona">Ventura Arjona</name><name sortKey="Bakay, Roy A E" sort="Bakay, Roy A E" uniqKey="Bakay R" first="Roy A. E." last="Bakay">Roy A. E. Bakay</name><name sortKey="Hariz, Marwan I" sort="Hariz, Marwan I" uniqKey="Hariz M" first="Marwan I." last="Hariz">Marwan I. Hariz</name><name sortKey="Martin Rodriguez, Jose G" sort="Martin Rodriguez, Jose G" uniqKey="Martin Rodriguez J" first="Jose G." last="Martin-Rodriguez">Jose G. Martin-Rodriguez</name><name sortKey="Pilitsis, Julie G" sort="Pilitsis, Julie G" uniqKey="Pilitsis J" first="Julie G." last="Pilitsis">Julie G. Pilitsis</name><name sortKey="Starr, Philip A" sort="Starr, Philip A" uniqKey="Starr P" first="Philip A." last="Starr">Philip A. Starr</name></noCountry><country name="Espagne"><noRegion><name sortKey="Guridi, Jorge" sort="Guridi, Jorge" uniqKey="Guridi J" first="Jorge" last="Guridi">Jorge Guridi</name></noRegion><name sortKey="Manrique, Miguel" sort="Manrique, Miguel" uniqKey="Manrique M" first="Miguel" last="Manrique">Miguel Manrique</name><name sortKey="Obeso, Jose A" sort="Obeso, Jose A" uniqKey="Obeso J" first="Jose A." last="Obeso">Jose A. Obeso</name><name sortKey="Rodriguez Oroz, Maria C" sort="Rodriguez Oroz, Maria C" uniqKey="Rodriguez Oroz M" first="Maria C." last="Rodriguez-Oroz">Maria C. Rodriguez-Oroz</name></country><country name="Canada"><region name="Ontario"><name sortKey="Lozano, Andres A" sort="Lozano, Andres A" uniqKey="Lozano A" first="Andres A." last="Lozano">Andres A. Lozano</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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