Effect of GPi pallidotomy on motor function in Parkinson's disease.
Identifieur interne : 001904 ( PubMed/Corpus ); précédent : 001903; suivant : 001905Effect of GPi pallidotomy on motor function in Parkinson's disease.
Auteurs : A M Lozano ; A E Lang ; N. Galvez-Jimenez ; J. Miyasaki ; J. Duff ; W D Hutchinson ; J O DostrovskySource :
- Lancet (London, England) [ 0140-6736 ] ; 1995.
English descriptors
- KwdEn :
- Activities of Daily Living, Adult, Aged, Dyskinesia, Drug-Induced (etiology), Dyskinesia, Drug-Induced (physiopathology), Female, Follow-Up Studies, Gait (physiology), Globus Pallidus (surgery), Humans, Levodopa (adverse effects), Male, Middle Aged, Motor Activity (physiology), Parkinson Disease (drug therapy), Parkinson Disease (physiopathology), Parkinson Disease (surgery), Stereotaxic Techniques, Tremor (physiopathology), Videotape Recording.
- MESH :
- chemical , adverse effects : Levodopa.
- drug therapy : Parkinson Disease.
- etiology : Dyskinesia, Drug-Induced.
- physiology : Gait, Motor Activity.
- physiopathology : Dyskinesia, Drug-Induced, Parkinson Disease, Tremor.
- surgery : Globus Pallidus, Parkinson Disease.
- Activities of Daily Living, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Stereotaxic Techniques, Videotape Recording.
Abstract
The major motor disturbances in Parkinson's disease are thought to be caused by overactivity of the internal segment of the globus pallidus (GPi), in large part due to excessive drive from the subthalamic nucleus. The excessive inhibitory activity of GPi is thought to "brake' the motor thalamus and the cortical motor system to produce the slowness, rigidity, and poverty of movement characteristic of parkinsonian states. To test the hypothesis that direct reduction of Gpi activity can improve motor function, we studied the effect of GPi pallidotomy in 14 patients. The location of the GPi nucleus was confirmed by microelectrode recording before lesion creation. Standardised videotape recordings before and after operation were randomised and scored by a "blinded' evaluator. 6 months after surgery, total motor score in the "off" state had improved by 30% and the total akinesia score by 33%. The gait score in the "off" state improved by 15% and a composite postural instability and gait score by 23%. After surgery there was almost total elimination of drug-induced involuntary movements (dyskinesias), with a 92% reduction on the side contralateral to the pallidotomy. No patient had visual or corticospinal complications. In these patients GPi pallidotomy enhanced motor performance, reduced akinesia, improved gait, and eliminated the neural elements responsible for levodopa-induced dyskinesias.
PubMed: 7475819
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Duff</name></author><author><name sortKey="Hutchinson, W D" sort="Hutchinson, W D" uniqKey="Hutchinson W" first="W D" last="Hutchinson">W D Hutchinson</name></author><author><name sortKey="Dostrovsky, J O" sort="Dostrovsky, J O" uniqKey="Dostrovsky J" first="J O" last="Dostrovsky">J O Dostrovsky</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="1995">1995</date><idno type="RBID">pubmed:7475819</idno><idno type="pmid">7475819</idno><idno type="wicri:Area/PubMed/Corpus">001904</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001904</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Effect of GPi pallidotomy on motor function in Parkinson's disease.</title><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A M" last="Lozano">A M Lozano</name><affiliation><nlm:affiliation>Department of Surgery, Toronto Hospital Neurological Centre, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A E" last="Lang">A E Lang</name></author><author><name sortKey="Galvez Jimenez, N" sort="Galvez Jimenez, N" uniqKey="Galvez Jimenez N" first="N" last="Galvez-Jimenez">N. Galvez-Jimenez</name></author><author><name sortKey="Miyasaki, J" sort="Miyasaki, J" uniqKey="Miyasaki J" first="J" last="Miyasaki">J. Miyasaki</name></author><author><name sortKey="Duff, J" sort="Duff, J" uniqKey="Duff J" first="J" last="Duff">J. Duff</name></author><author><name sortKey="Hutchinson, W D" sort="Hutchinson, W D" uniqKey="Hutchinson W" first="W D" last="Hutchinson">W D Hutchinson</name></author><author><name sortKey="Dostrovsky, J O" sort="Dostrovsky, J O" uniqKey="Dostrovsky J" first="J O" last="Dostrovsky">J O Dostrovsky</name></author></analytic><series><title level="j">Lancet (London, England)</title><idno type="ISSN">0140-6736</idno><imprint><date when="1995" type="published">1995</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Activities of Daily Living</term><term>Adult</term><term>Aged</term><term>Dyskinesia, Drug-Induced (etiology)</term><term>Dyskinesia, Drug-Induced (physiopathology)</term><term>Female</term><term>Follow-Up Studies</term><term>Gait (physiology)</term><term>Globus Pallidus (surgery)</term><term>Humans</term><term>Levodopa (adverse effects)</term><term>Male</term><term>Middle Aged</term><term>Motor Activity (physiology)</term><term>Parkinson Disease (drug therapy)</term><term>Parkinson Disease (physiopathology)</term><term>Parkinson Disease (surgery)</term><term>Stereotaxic Techniques</term><term>Tremor (physiopathology)</term><term>Videotape Recording</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Levodopa</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Dyskinesia, Drug-Induced</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Gait</term><term>Motor Activity</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Dyskinesia, Drug-Induced</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>Activities of Daily Living</term><term>Adult</term><term>Aged</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Stereotaxic Techniques</term><term>Videotape Recording</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The major motor disturbances in Parkinson's disease are thought to be caused by overactivity of the internal segment of the globus pallidus (GPi), in large part due to excessive drive from the subthalamic nucleus. The excessive inhibitory activity of GPi is thought to "brake' the motor thalamus and the cortical motor system to produce the slowness, rigidity, and poverty of movement characteristic of parkinsonian states. To test the hypothesis that direct reduction of Gpi activity can improve motor function, we studied the effect of GPi pallidotomy in 14 patients. The location of the GPi nucleus was confirmed by microelectrode recording before lesion creation. Standardised videotape recordings before and after operation were randomised and scored by a "blinded' evaluator. 6 months after surgery, total motor score in the "off" state had improved by 30% and the total akinesia score by 33%. The gait score in the "off" state improved by 15% and a composite postural instability and gait score by 23%. After surgery there was almost total elimination of drug-induced involuntary movements (dyskinesias), with a 92% reduction on the side contralateral to the pallidotomy. No patient had visual or corticospinal complications. In these patients GPi pallidotomy enhanced motor performance, reduced akinesia, improved gait, and eliminated the neural elements responsible for levodopa-induced dyskinesias.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">7475819</PMID><DateCreated><Year>1995</Year><Month>12</Month><Day>15</Day></DateCreated><DateCompleted><Year>1995</Year><Month>12</Month><Day>15</Day></DateCompleted><DateRevised><Year>2015</Year><Month>06</Month><Day>16</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0140-6736</ISSN><JournalIssue CitedMedium="Print"><Volume>346</Volume><Issue>8987</Issue><PubDate><Year>1995</Year><Month>Nov</Month><Day>25</Day></PubDate></JournalIssue><Title>Lancet (London, England)</Title><ISOAbbreviation>Lancet</ISOAbbreviation></Journal><ArticleTitle>Effect of GPi pallidotomy on motor function in Parkinson's disease.</ArticleTitle><Pagination><MedlinePgn>1383-7</MedlinePgn></Pagination><Abstract><AbstractText>The major motor disturbances in Parkinson's disease are thought to be caused by overactivity of the internal segment of the globus pallidus (GPi), in large part due to excessive drive from the subthalamic nucleus. The excessive inhibitory activity of GPi is thought to "brake' the motor thalamus and the cortical motor system to produce the slowness, rigidity, and poverty of movement characteristic of parkinsonian states. To test the hypothesis that direct reduction of Gpi activity can improve motor function, we studied the effect of GPi pallidotomy in 14 patients. The location of the GPi nucleus was confirmed by microelectrode recording before lesion creation. Standardised videotape recordings before and after operation were randomised and scored by a "blinded' evaluator. 6 months after surgery, total motor score in the "off" state had improved by 30% and the total akinesia score by 33%. The gait score in the "off" state improved by 15% and a composite postural instability and gait score by 23%. After surgery there was almost total elimination of drug-induced involuntary movements (dyskinesias), with a 92% reduction on the side contralateral to the pallidotomy. No patient had visual or corticospinal complications. In these patients GPi pallidotomy enhanced motor performance, reduced akinesia, improved gait, and eliminated the neural elements responsible for levodopa-induced dyskinesias.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Lozano</LastName><ForeName>A M</ForeName><Initials>AM</Initials><AffiliationInfo><Affiliation>Department of Surgery, Toronto Hospital Neurological Centre, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lang</LastName><ForeName>A E</ForeName><Initials>AE</Initials></Author><Author ValidYN="Y"><LastName>Galvez-Jimenez</LastName><ForeName>N</ForeName><Initials>N</Initials></Author><Author ValidYN="Y"><LastName>Miyasaki</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Duff</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Hutchinson</LastName><ForeName>W D</ForeName><Initials>WD</Initials></Author><Author ValidYN="Y"><LastName>Dostrovsky</LastName><ForeName>J O</ForeName><Initials>JO</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016430">Clinical Trial</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Lancet</MedlineTA><NlmUniqueID>2985213R</NlmUniqueID><ISSNLinking>0140-6736</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>46627O600J</RegistryNumber><NameOfSubstance UI="D007980">Levodopa</NameOfSubstance></Chemical></ChemicalList><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Lancet. 1996 May 25;347(9013):1490</RefSource><PMID Version="1">8676663</PMID></CommentsCorrections><CommentsCorrections RefType="ErratumIn"><RefSource>Lancet 1996 Oct 19;348(9034):1108</RefSource></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000203" MajorTopicYN="N">Activities of Daily Living</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004409" MajorTopicYN="N">Dyskinesia, Drug-Induced</DescriptorName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005500" MajorTopicYN="N">Follow-Up Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005684" MajorTopicYN="N">Gait</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005917" MajorTopicYN="N">Globus Pallidus</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007980" MajorTopicYN="N">Levodopa</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009043" MajorTopicYN="N">Motor Activity</DescriptorName><QualifierName UI="Q000502" 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