Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease.
Identifieur interne : 001725 ( PubMed/Curation ); précédent : 001724; suivant : 001726Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease.
Auteurs : R E Gross [Canada] ; W J Lombardi ; A E Lang ; J. Duff ; W D Hutchison ; J A Saint-Cyr ; R R Tasker ; A M LozanoSource :
- Brain : a journal of neurology [ 0006-8950 ] ; 1999.
English descriptors
- KwdEn :
- Aged, Dyskinesia, Drug-Induced (physiopathology), Female, Functional Laterality, Gait, Globus Pallidus (pathology), Globus Pallidus (surgery), Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Microelectrodes, Middle Aged, Motor Activity, Muscle Rigidity (physiopathology), Neurosurgical Procedures, Parkinson Disease (pathology), Parkinson Disease (physiopathology), Parkinson Disease (surgery), Posture, Prospective Studies, Regression Analysis, Treatment Outcome, Tremor (physiopathology).
- 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.
PubMed: 10094250
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Duff</name></author><author><name sortKey="Hutchison, W D" sort="Hutchison, W D" uniqKey="Hutchison W" first="W D" last="Hutchison">W D Hutchison</name></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></author><author><name sortKey="Tasker, R R" sort="Tasker, R R" uniqKey="Tasker R" first="R R" last="Tasker">R R Tasker</name></author><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A M" last="Lozano">A M Lozano</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="1999">1999</date><idno type="RBID">pubmed:10094250</idno><idno type="pmid">10094250</idno><idno type="wicri:Area/PubMed/Corpus">001725</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001725</idno><idno type="wicri:Area/PubMed/Curation">001725</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">001725</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease.</title><author><name sortKey="Gross, R E" sort="Gross, R E" uniqKey="Gross R" first="R E" last="Gross">R E Gross</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, University of Toronto, The Toronto Hospital, Ontario, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Surgery, University of Toronto, The Toronto Hospital, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="Lombardi, W J" sort="Lombardi, W J" uniqKey="Lombardi W" first="W J" last="Lombardi">W J Lombardi</name></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="Duff, J" sort="Duff, J" uniqKey="Duff J" first="J" last="Duff">J. Duff</name></author><author><name sortKey="Hutchison, W D" sort="Hutchison, W D" uniqKey="Hutchison W" first="W D" last="Hutchison">W D Hutchison</name></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></author><author><name sortKey="Tasker, R R" sort="Tasker, R R" uniqKey="Tasker R" first="R R" last="Tasker">R R Tasker</name></author><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A M" last="Lozano">A M Lozano</name></author></analytic><series><title level="j">Brain : a journal of neurology</title><idno type="ISSN">0006-8950</idno><imprint><date when="1999" type="published">1999</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Dyskinesia, Drug-Induced (physiopathology)</term><term>Female</term><term>Functional Laterality</term><term>Gait</term><term>Globus Pallidus (pathology)</term><term>Globus Pallidus (surgery)</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>Muscle Rigidity (physiopathology)</term><term>Neurosurgical Procedures</term><term>Parkinson Disease (pathology)</term><term>Parkinson Disease (physiopathology)</term><term>Parkinson Disease (surgery)</term><term>Posture</term><term>Prospective Studies</term><term>Regression Analysis</term><term>Treatment Outcome</term><term>Tremor (physiopathology)</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></textClass></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><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">10094250</PMID><DateCreated><Year>1999</Year><Month>04</Month><Day>13</Day></DateCreated><DateCompleted><Year>1999</Year><Month>04</Month><Day>13</Day></DateCompleted><DateRevised><Year>2006</Year><Month>11</Month><Day>15</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0006-8950</ISSN><JournalIssue CitedMedium="Print"><Volume>122 ( Pt 3)</Volume><PubDate><Year>1999</Year><Month>Mar</Month></PubDate></JournalIssue><Title>Brain : a journal of neurology</Title><ISOAbbreviation>Brain</ISOAbbreviation></Journal><ArticleTitle>Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease.</ArticleTitle><Pagination><MedlinePgn>405-16</MedlinePgn></Pagination><Abstract><AbstractText>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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Gross</LastName><ForeName>R E</ForeName><Initials>RE</Initials><AffiliationInfo><Affiliation>Department of Surgery, University of Toronto, The Toronto Hospital, Ontario, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lombardi</LastName><ForeName>W J</ForeName><Initials>WJ</Initials></Author><Author ValidYN="Y"><LastName>Lang</LastName><ForeName>A E</ForeName><Initials>AE</Initials></Author><Author ValidYN="Y"><LastName>Duff</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Hutchison</LastName><ForeName>W D</ForeName><Initials>WD</Initials></Author><Author ValidYN="Y"><LastName>Saint-Cyr</LastName><ForeName>J A</ForeName><Initials>JA</Initials></Author><Author ValidYN="Y"><LastName>Tasker</LastName><ForeName>R R</ForeName><Initials>RR</Initials></Author><Author ValidYN="Y"><LastName>Lozano</LastName><ForeName>A M</ForeName><Initials>AM</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016430">Clinical Trial</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Brain</MedlineTA><NlmUniqueID>0372537</NlmUniqueID><ISSNLinking>0006-8950</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Brain. 1999 Mar;122 ( Pt 3):381-2</RefSource><PMID Version="1">10094248</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004409" MajorTopicYN="N">Dyskinesia, Drug-Induced</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007839" MajorTopicYN="N">Functional Laterality</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005684" MajorTopicYN="N">Gait</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005917" MajorTopicYN="N">Globus Pallidus</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007091" MajorTopicYN="N">Image Processing, Computer-Assisted</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008279" MajorTopicYN="N">Magnetic Resonance Imaging</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008839" MajorTopicYN="N">Microelectrodes</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009043" MajorTopicYN="N">Motor Activity</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009127" MajorTopicYN="N">Muscle Rigidity</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019635" MajorTopicYN="Y">Neurosurgical Procedures</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D010300" MajorTopicYN="N">Parkinson Disease</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011187" MajorTopicYN="N">Posture</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012044" MajorTopicYN="N">Regression Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014202" MajorTopicYN="N">Tremor</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>1999</Year><Month>3</Month><Day>27</Day></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>1999</Year><Month>3</Month><Day>27</Day><Hour>0</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>1999</Year><Month>3</Month><Day>27</Day><Hour>0</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">10094250</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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