Neuropsychological outcome of GPI pallidotomy and GPI or STN deep brain stimulation in Parkinson's disease
Identifieur interne : 003572 ( Main/Exploration ); précédent : 003571; suivant : 003573Neuropsychological outcome of GPI pallidotomy and GPI or STN deep brain stimulation in Parkinson's disease
Auteurs : L. L. Trepanier [Canada] ; R. Kumar [Canada] ; A. M. Lozano [Canada] ; A. E. Lang [Canada] ; J. A. Saint-Cyr [Canada]Source :
- Brain and cognition : (Print) [ 0278-2626 ] ; 2000.
Descripteurs français
- Pascal (Inist)
- Wicri :
English descriptors
- KwdEn :
- Adult, Aged, Basal Ganglia (drug effects), Basal Ganglia (pathology), Brain (pathology), Brain (physiology), Brain (vertebrata), Cognition Disorders (diagnosis), Cognition Disorders (etiology), Cognitive disorder, Dyskinesia, Drug-Induced (etiology), Electric Stimulation (methods), Female, Globus Pallidus (physiology), Globus Pallidus (surgery), Human, Humans, Instrumental stimulation, Levodopa (adverse effects), Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Neurosurgical Procedures, Pallidum, Parkinson Disease (psychology), Parkinson Disease (surgery), Parkinson disease, Postoperative Complications, Preoperative Care, Sequela, Subthalamic Nucleus (physiology), Surgery, Surveys and Questionnaires.
- MESH :
- chemical , adverse effects : Levodopa.
- diagnosis : Cognition Disorders.
- drug effects : Basal Ganglia.
- etiology : Cognition Disorders, Dyskinesia, Drug-Induced.
- methods : Electric Stimulation.
- pathology : Basal Ganglia, Brain.
- physiology : Brain, Globus Pallidus, Subthalamic Nucleus.
- psychology : Parkinson Disease.
- surgery : Globus Pallidus, Parkinson Disease.
- Adult, Aged, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Neurosurgical Procedures, Postoperative Complications, Preoperative Care, Surveys and Questionnaires.
Abstract
This paper highlights the neuropsychological sequelae of posteroventral pallidotomy (PVP) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the internal segment of the globus pallidus (GPi) at 3/6 months postoperatively. Results are based on our extensive experience with PVP and our preliminary observations with DBS. Patients with borderline cognitive or psychiatric functioning risk postoperative decompensation. Nonlateralizing attentional and hemisphere-specific impairments of frontostriatal cognitive functions followed unilateral PVP. "Frontal" behavioral dyscontrol was observed in approximately 25% of patients. Three cases of staged bilateral PVP suggest that premorbid factors may predict outcome, although lesion size and location are also critical. Older patients are at risk for significant cognitive and behavioral decline after bilateral STN DBS, while GPi DBS may be safer.
Affiliations:
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L." last="Trepanier">L. L. 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Kumar</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Division of Neurology, University of Toronto and Morton and Gloria Shulman Movement Disorder Centre at The Toronto Hospital</s1><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Department of Medicine, Division of Neurology, University of Toronto and Morton and Gloria Shulman Movement Disorder Centre at The Toronto Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Toronto Western Hospital-Research Institute</s1><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto Western Hospital-Research Institute</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Surgery, Division of Neurosurgery, University of Toronto and The Toronto Hospital</s1><s3>CAN</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Department of Surgery, Division of Neurosurgery, University of Toronto and The Toronto Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Division of Neurology, University of Toronto and Morton and Gloria Shulman Movement Disorder Centre at The Toronto Hospital</s1><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Department of Medicine, Division of Neurology, University of Toronto and Morton and Gloria Shulman Movement Disorder Centre at The Toronto Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Toronto Western Hospital-Research Institute</s1><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto Western Hospital-Research Institute</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Division of Neurology, University of Toronto and Morton and Gloria Shulman Movement Disorder Centre at The Toronto Hospital</s1><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Department of Medicine, Division of Neurology, University of Toronto and Morton and Gloria Shulman Movement Disorder Centre at The Toronto Hospital</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Psychology, York University</s1><s2>North York, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>North York, Ontario</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Surgery, Division of Neurosurgery, University of Toronto and The Toronto Hospital</s1><s3>CAN</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Department of Surgery, Division of Neurosurgery, University of Toronto and The Toronto Hospital</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Department of Psychology, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>5 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></analytic><series><title level="j" type="main">Brain and cognition : (Print)</title><title level="j" type="abbreviated">Brain cogn. : (Print)</title><idno type="ISSN">0278-2626</idno><imprint><date when="2000">2000</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Brain and cognition : (Print)</title><title level="j" type="abbreviated">Brain cogn. : (Print)</title><idno type="ISSN">0278-2626</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Basal Ganglia (drug effects)</term><term>Basal Ganglia (pathology)</term><term>Brain (pathology)</term><term>Brain (physiology)</term><term>Brain (vertebrata)</term><term>Cognition Disorders (diagnosis)</term><term>Cognition Disorders (etiology)</term><term>Cognitive disorder</term><term>Dyskinesia, Drug-Induced (etiology)</term><term>Electric Stimulation (methods)</term><term>Female</term><term>Globus Pallidus (physiology)</term><term>Globus Pallidus (surgery)</term><term>Human</term><term>Humans</term><term>Instrumental stimulation</term><term>Levodopa (adverse effects)</term><term>Magnetic Resonance Imaging</term><term>Male</term><term>Middle Aged</term><term>Neuropsychological Tests</term><term>Neurosurgical Procedures</term><term>Pallidum</term><term>Parkinson Disease (psychology)</term><term>Parkinson Disease (surgery)</term><term>Parkinson disease</term><term>Postoperative Complications</term><term>Preoperative Care</term><term>Sequela</term><term>Subthalamic Nucleus (physiology)</term><term>Surgery</term><term>Surveys and Questionnaires</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Levodopa</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Cognition Disorders</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Basal Ganglia</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Cognition Disorders</term><term>Dyskinesia, Drug-Induced</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Electric Stimulation</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Basal Ganglia</term><term>Brain</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Brain</term><term>Globus Pallidus</term><term>Subthalamic Nucleus</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Globus Pallidus</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Female</term><term>Humans</term><term>Magnetic Resonance Imaging</term><term>Male</term><term>Middle Aged</term><term>Neuropsychological Tests</term><term>Neurosurgical Procedures</term><term>Postoperative Complications</term><term>Preoperative Care</term><term>Surveys and Questionnaires</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term><term>Chirurgie</term><term>Encéphale</term><term>Pallidum</term><term>Stimulation instrumentale</term><term>Séquelle</term><term>Trouble cognition</term><term>Homme</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">This paper highlights the neuropsychological sequelae of posteroventral pallidotomy (PVP) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the internal segment of the globus pallidus (GPi) at 3/6 months postoperatively. Results are based on our extensive experience with PVP and our preliminary observations with DBS. Patients with borderline cognitive or psychiatric functioning risk postoperative decompensation. Nonlateralizing attentional and hemisphere-specific impairments of frontostriatal cognitive functions followed unilateral PVP. "Frontal" behavioral dyscontrol was observed in approximately 25% of patients. Three cases of staged bilateral PVP suggest that premorbid factors may predict outcome, although lesion size and location are also critical. Older patients are at risk for significant cognitive and behavioral decline after bilateral STN DBS, while GPi DBS may be safer.</div></front></TEI><affiliations><list><country><li>Canada</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><noRegion><name sortKey="Trepanier, L L" sort="Trepanier, L L" uniqKey="Trepanier L" first="L. L." last="Trepanier">L. L. Trepanier</name></noRegion><name sortKey="Kumar, R" sort="Kumar, R" uniqKey="Kumar R" first="R." last="Kumar">R. Kumar</name><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A. M." last="Lozano">A. M. Lozano</name><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J. A." last="Saint-Cyr">J. A. Saint-Cyr</name><name sortKey="Trepanier, L L" sort="Trepanier, L L" uniqKey="Trepanier L" first="L. L." last="Trepanier">L. L. Trepanier</name><name sortKey="Trepanier, L L" sort="Trepanier, L L" uniqKey="Trepanier L" first="L. L." last="Trepanier">L. L. Trepanier</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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