Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease
Identifieur interne : 003716 ( Main/Exploration ); précédent : 003715; suivant : 003717Relationship 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 [Canada] ; Ronald R. Tasker ; Andres M. LozanoSource :
- Brain [ 0006-8950 ] ; 1999-03.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
- Aged, Dyskinesia, Drug-Induced (physiopathology), Evolution, Female, Functional Laterality, GPe = globus pallidus externus, GPi = globus pallidus internus, Gait, Globus Pallidus (pathology), Globus Pallidus (surgery), Human, Humans, Image Processing, Computer-Assisted, Localization, Magnetic Resonance Imaging, Male, Microelectrode, Microelectrodes, Middle Aged, Motor Activity, Muscle Rigidity (physiopathology), Neurosurgical Procedures, Nuclear magnetic resonance imaging, Pallidum, Parkinson Disease (pathology), Parkinson Disease (physiopathology), Parkinson Disease (surgery), Parkinson disease, Parkinson's disease, Posture, Prospective Studies, Regression Analysis, Section, Treatment Outcome, Tremor (physiopathology), UPDRS = Unified Parkinson's Disease Rating Scale, clinical outcome, globus pallidus, pallidotomy, vMRI = volumetric MRI.
- MESH :
- pathology : Globus Pallidus, Parkinson Disease.
- physiopathology : Dyskinesia, Drug-Induced, Muscle Rigidity, Parkinson Disease, Tremor.
- surgery : Globus Pallidus, Parkinson Disease.
- Aged, Female, Functional Laterality, Gait, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Microelectrodes, Middle Aged, Motor Activity, Neurosurgical Procedures, Posture, Prospective Studies, Regression Analysis, Treatment Outcome.
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.
Url:
DOI: 10.1093/brain/122.3.405
Affiliations:
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Tasker</name><affiliation><wicri:noCountry code="subField"></wicri:noCountry></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><wicri:noCountry code="subField"></wicri:noCountry></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>Aged</term><term>Dyskinesia, Drug-Induced (physiopathology)</term><term>Evolution</term><term>Female</term><term>Functional Laterality</term><term>GPe = globus pallidus externus</term><term>GPi = globus pallidus internus</term><term>Gait</term><term>Globus Pallidus (pathology)</term><term>Globus Pallidus (surgery)</term><term>Human</term><term>Humans</term><term>Image Processing, Computer-Assisted</term><term>Localization</term><term>Magnetic Resonance Imaging</term><term>Male</term><term>Microelectrode</term><term>Microelectrodes</term><term>Middle Aged</term><term>Motor Activity</term><term>Muscle Rigidity (physiopathology)</term><term>Neurosurgical Procedures</term><term>Nuclear magnetic resonance imaging</term><term>Pallidum</term><term>Parkinson Disease (pathology)</term><term>Parkinson Disease (physiopathology)</term><term>Parkinson Disease (surgery)</term><term>Parkinson disease</term><term>Parkinson's disease</term><term>Posture</term><term>Prospective Studies</term><term>Regression Analysis</term><term>Section</term><term>Treatment Outcome</term><term>Tremor (physiopathology)</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><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Globus Pallidus</term><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Dyskinesia, Drug-Induced</term><term>Muscle Rigidity</term><term>Parkinson Disease</term><term>Tremor</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>Aged</term><term>Female</term><term>Functional Laterality</term><term>Gait</term><term>Humans</term><term>Image Processing, Computer-Assisted</term><term>Magnetic Resonance Imaging</term><term>Male</term><term>Microelectrodes</term><term>Middle Aged</term><term>Motor Activity</term><term>Neurosurgical Procedures</term><term>Posture</term><term>Prospective Studies</term><term>Regression Analysis</term><term>Treatment Outcome</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Evolution</term><term>Homme</term><term>Imagerie RMN</term><term>Localisation</term><term>Microélectrode</term><term>Pallidum</term><term>Parkinson maladie</term><term>Section</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</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><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><noCountry><name sortKey="Duff, Jan" sort="Duff, Jan" uniqKey="Duff J" first="Jan" last="Duff">Jan Duff</name><name sortKey="Gross, Robert E" sort="Gross, Robert E" uniqKey="Gross R" first="Robert E." last="Gross">Robert E. Gross</name><name sortKey="Hutchison, William D" sort="Hutchison, William D" uniqKey="Hutchison W" first="William D." last="Hutchison">William D. Hutchison</name><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name><name sortKey="Lombardi, Wendy J" sort="Lombardi, Wendy J" uniqKey="Lombardi W" first="Wendy J." last="Lombardi">Wendy J. Lombardi</name><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><name sortKey="Tasker, Ronald R" sort="Tasker, Ronald R" uniqKey="Tasker R" first="Ronald R." last="Tasker">Ronald R. Tasker</name></noCountry><country name="Canada"><region name="Ontario"><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></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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