Pallidotomy for Parkinson disease : a review of contemporary literature
Identifieur interne : 003777 ( Main/Merge ); précédent : 003776; suivant : 003778Pallidotomy for Parkinson disease : a review of contemporary literature
Auteurs : Ahmed Alkhani [Canada] ; Andres M. Lozano [Canada]Source :
- Journal of neurosurgery [ 0022-3085 ] ; 2001.
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- Pascal (Inist)
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Abstract
Object. The authors conducted an evidence-based review of contemporary published articles on pallidotomy to obtain an appraisal of this procedure in the treatment of Parkinson disease (PD). Methods. A search of the Pubmed database performed using the key word "pallidotomy" yielded 263 articles cited between January 1, 1992, and July 1, 1999. Articles that included original, nonduplicated descriptions of patients with PD treated with radiofrequency pallidotomy were selected. In 85 articles identified for critical review, 1959 patients with PD underwent pallidotomies at 40 centers in 12 countries. There were 1735 unilateral (88.6%) and 224 bilateral procedures (11.4%). The mean age of the patients was 61.4 ± 3.6 years and the mean duration of PD symptoms in these patients was 12.3 ± 1.9 years. Microelectrode recordings were used in 46.2% of cases. Outcomes were objectively documented using the Unified Parkinson Disease Rating Scale (UPDRS) in 501 (25.6%) of the cases at 6 months and in 218 (11.1%) of the cases at I year. There was a consensus on the benefits of pallidotomy for off period motor function and on period, drug-induced dyskinesias, with variations in the extent of symptomatic benefit across studies. At the 1-year assessment, the mean improvement in the UPDRS motor score during off periods was 45.3% and the mean improvement in contralateral dyskinesias during on periods was 86.4%. The overall mortality rate was 0.4% and the rate of persistent adverse effects was estimated at 14%. Major adverse events, including intracerebral hemorrhages, contralateral weakness, and visual field defects, occurred in 5.3% of patients reported. Conclusions. Unilateral pallidotomy is effective and relatively safe in the treatment of PD; however, limited data are available on the long-term outcome of this procedure.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Pallidotomy for Parkinson disease : a review of contemporary literature</title><author><name sortKey="Alkhani, Ahmed" sort="Alkhani, Ahmed" uniqKey="Alkhani A" first="Ahmed" last="Alkhani">Ahmed Alkhani</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto, Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></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:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto, Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">01-0077509</idno><date when="2001">2001</date><idno type="stanalyst">PASCAL 01-0077509 INIST</idno><idno type="RBID">Pascal:01-0077509</idno><idno type="wicri:Area/PascalFrancis/Corpus">000C52</idno><idno type="wicri:Area/PascalFrancis/Curation">000071</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000A70</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000A70</idno><idno type="wicri:doubleKey">0022-3085:2001:Alkhani A:pallidotomy:for:parkinson</idno><idno type="wicri:Area/Main/Merge">003777</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Pallidotomy for Parkinson disease : a review of contemporary literature</title><author><name sortKey="Alkhani, Ahmed" sort="Alkhani, Ahmed" uniqKey="Alkhani A" first="Ahmed" last="Alkhani">Ahmed Alkhani</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto, Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></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:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, University of Toronto, Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of neurosurgery</title><title level="j" type="abbreviated">J. neurosurg.</title><idno type="ISSN">0022-3085</idno><imprint><date when="2001">2001</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of neurosurgery</title><title level="j" type="abbreviated">J. neurosurg.</title><idno type="ISSN">0022-3085</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Bibliographic survey</term><term>Human</term><term>Pallidum</term><term>Parkinson disease</term><term>Surgical section</term><term>Treatment</term><term>Unilateral</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term><term>Pallidum</term><term>Section chirurgicale</term><term>Unilatéral</term><term>Synthèse bibliographique</term><term>Traitement</term><term>Homme</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Object. The authors conducted an evidence-based review of contemporary published articles on pallidotomy to obtain an appraisal of this procedure in the treatment of Parkinson disease (PD). Methods. A search of the Pubmed database performed using the key word "pallidotomy" yielded 263 articles cited between January 1, 1992, and July 1, 1999. Articles that included original, nonduplicated descriptions of patients with PD treated with radiofrequency pallidotomy were selected. In 85 articles identified for critical review, 1959 patients with PD underwent pallidotomies at 40 centers in 12 countries. There were 1735 unilateral (88.6%) and 224 bilateral procedures (11.4%). The mean age of the patients was 61.4 ± 3.6 years and the mean duration of PD symptoms in these patients was 12.3 ± 1.9 years. Microelectrode recordings were used in 46.2% of cases. Outcomes were objectively documented using the Unified Parkinson Disease Rating Scale (UPDRS) in 501 (25.6%) of the cases at 6 months and in 218 (11.1%) of the cases at I year. There was a consensus on the benefits of pallidotomy for off period motor function and on period, drug-induced dyskinesias, with variations in the extent of symptomatic benefit across studies. At the 1-year assessment, the mean improvement in the UPDRS motor score during off periods was 45.3% and the mean improvement in contralateral dyskinesias during on periods was 86.4%. The overall mortality rate was 0.4% and the rate of persistent adverse effects was estimated at 14%. Major adverse events, including intracerebral hemorrhages, contralateral weakness, and visual field defects, occurred in 5.3% of patients reported. Conclusions. Unilateral pallidotomy is effective and relatively safe in the treatment of PD; however, limited data are available on the long-term outcome of this procedure.</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"><region name="Ontario"><name sortKey="Alkhani, Ahmed" sort="Alkhani, Ahmed" uniqKey="Alkhani A" first="Ahmed" last="Alkhani">Ahmed Alkhani</name></region><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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