Treatment of advanced Parkinson's disease by unilateral posterior GPi pallidotomy: 4‐year results of a pilot study
Identifieur interne : 000484 ( Istex/Corpus ); précédent : 000483; suivant : 000485Treatment of advanced Parkinson's disease by unilateral posterior GPi pallidotomy: 4‐year results of a pilot study
Auteurs : Mark S. Baron ; Jerrold L. Vitek ; Roy A. E. Bakay ; Joanne Green ; William M. Mcdonald ; Steven A. Cole ; Mahlon R. DelongSource :
- Movement Disorders [ 0885-3185 ] ; 2000-03.
English descriptors
Abstract
To assess the long‐term outcome following unilateral pallidotomy for advanced Parkinson's disease, we performed nonblinded Core Assessment Program for Intracerebral Transplantations protocol assessments in 10 of the original 15 patients in our pilot study for 4 years following surgery. Although Unified Parkinson's Disease Rating Scale motor examination scores returned to baseline levels at 3 and 4 years, most patients continued to show sustained improvements in contralateral tremor, akinesia, and drug‐induced dyskinesias. Contralateral tremor was absent at 4 years in all seven patients with preoperative tremor. Contralateral “off” arm movement times (averaged for three tasks) decreased by 37% at 1 year and by 30% at 4 years. Contralateral dyskinesia scores improved by 82% at 1 year and by 64% at 4 years. In contrast, after reaching speeds equal to the contralateral side at 1 year, ipsilateral “off” movement times increased by 13% over baseline levels at 4 years. Although most gait and postural stability measures showed modest initial improvement followed by a return to baseline values, “on” stand–walk–sit task performance declined significantly at 4 years. Despite the restriction of our surgeries to one side and the expected natural progression of Parkinson's disease, the results of patient self‐assessments suggest that 4 years after unilateral pallidotomy, most patients continue to experience a quality of life above preoperative levels.
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DOI: 10.1002/1531-8257(200003)15:2<230::AID-MDS1005>3.0.CO;2-U
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Although Unified Parkinson's Disease Rating Scale motor examination scores returned to baseline levels at 3 and 4 years, most patients continued to show sustained improvements in contralateral tremor, akinesia, and drug‐induced dyskinesias. Contralateral tremor was absent at 4 years in all seven patients with preoperative tremor. Contralateral “off” arm movement times (averaged for three tasks) decreased by 37% at 1 year and by 30% at 4 years. Contralateral dyskinesia scores improved by 82% at 1 year and by 64% at 4 years. In contrast, after reaching speeds equal to the contralateral side at 1 year, ipsilateral “off” movement times increased by 13% over baseline levels at 4 years. Although most gait and postural stability measures showed modest initial improvement followed by a return to baseline values, “on” stand–walk–sit task performance declined significantly at 4 years. Despite the restriction of our surgeries to one side and the expected natural progression of Parkinson's disease, the results of patient self‐assessments suggest that 4 years after unilateral pallidotomy, most patients continue to experience a quality of life above preoperative levels.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Mark S. Baron MD</name><affiliations><json:string>Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</json:string></affiliations></json:item><json:item><name>Jerrold L. Vitek MD, PhD</name><affiliations><json:string>Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</json:string></affiliations></json:item><json:item><name>Roy A. E. Bakay MD</name><affiliations><json:string>Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</json:string></affiliations></json:item><json:item><name>Joanne Green PhD</name><affiliations><json:string>Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</json:string></affiliations></json:item><json:item><name>William M. McDonald MD</name><affiliations><json:string>Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</json:string></affiliations></json:item><json:item><name>Steven A. Cole MD</name><affiliations><json:string>Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</json:string></affiliations></json:item><json:item><name>Mahlon R. DeLong MD</name><affiliations><json:string>Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Pallidotomy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Stereotaxic surgery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item></subject><language><json:string>eng</json:string></language><abstract>To assess the long‐term outcome following unilateral pallidotomy for advanced Parkinson's disease, we performed nonblinded Core Assessment Program for Intracerebral Transplantations protocol assessments in 10 of the original 15 patients in our pilot study for 4 years following surgery. 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Although Unified Parkinson's Disease Rating Scale motor examination scores returned to baseline levels at 3 and 4 years, most patients continued to show sustained improvements in contralateral tremor, akinesia, and drug‐induced dyskinesias. Contralateral tremor was absent at 4 years in all seven patients with preoperative tremor. Contralateral “off” arm movement times (averaged for three tasks) decreased by 37% at 1 year and by 30% at 4 years. Contralateral dyskinesia scores improved by 82% at 1 year and by 64% at 4 years. In contrast, after reaching speeds equal to the contralateral side at 1 year, ipsilateral “off” movement times increased by 13% over baseline levels at 4 years. Although most gait and postural stability measures showed modest initial improvement followed by a return to baseline values, “on” stand–walk–sit task performance declined significantly at 4 years. 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E.</givenNames><familyName>Bakay</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Joanne</givenNames><familyName>Green</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af3"><personName><givenNames>William M.</givenNames><familyName>McDonald</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Steven A.</givenNames><familyName>Cole</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Mahlon R.</givenNames><familyName>DeLong</familyName><degrees>MD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="US" type="organization"><unparsedAffiliation>Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="US" type="organization"><unparsedAffiliation>Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="US" type="organization"><unparsedAffiliation>Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Pallidotomy</keyword><keyword xml:id="kwd2">Stereotaxic surgery</keyword><keyword xml:id="kwd3">Parkinson's disease</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>To assess the long‐term outcome following unilateral pallidotomy for advanced Parkinson's disease, we performed nonblinded Core Assessment Program for Intracerebral Transplantations protocol assessments in 10 of the original 15 patients in our pilot study for 4 years following surgery. Although Unified Parkinson's Disease Rating Scale motor examination scores returned to baseline levels at 3 and 4 years, most patients continued to show sustained improvements in contralateral tremor, akinesia, and drug‐induced dyskinesias. Contralateral tremor was absent at 4 years in all seven patients with preoperative tremor. Contralateral “off” arm movement times (averaged for three tasks) decreased by 37% at 1 year and by 30% at 4 years. Contralateral dyskinesia scores improved by 82% at 1 year and by 64% at 4 years. In contrast, after reaching speeds equal to the contralateral side at 1 year, ipsilateral “off” movement times increased by 13% over baseline levels at 4 years. Although most gait and postural stability measures showed modest initial improvement followed by a return to baseline values, “on” stand–walk–sit task performance declined significantly at 4 years. Despite the restriction of our surgeries to one side and the expected natural progression of Parkinson's disease, the results of patient self‐assessments suggest that 4 years after unilateral pallidotomy, most patients continue to experience a quality of life above preoperative levels.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><!--Version 0.6 générée le 4-12-2015--><mods version="3.6"><titleInfo lang="en"><title>Treatment of advanced Parkinson's disease by unilateral posterior GPi pallidotomy: 4‐year results of a pilot study</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Four‐Year Results of Pallidotomy for PD</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Treatment of advanced Parkinson's disease by unilateral posterior GPi pallidotomy: 4‐year results of a pilot study</title></titleInfo><name type="personal"><namePart type="given">Mark S.</namePart><namePart type="family">Baron</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</affiliation><description>Correspondence: Emory University, 6000 WMRB, Atlanta, GA 30322, U.S.A.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jerrold L.</namePart><namePart type="family">Vitek</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Roy A. E.</namePart><namePart type="family">Bakay</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Joanne</namePart><namePart type="family">Green</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">William M.</namePart><namePart type="family">McDonald</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Steven A.</namePart><namePart type="family">Cole</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mahlon R.</namePart><namePart type="family">DeLong</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre authority="originalCategForm">article</genre><originInfo><publisher>John Wiley & Sons, Inc.</publisher><place><placeTerm type="text">New York</placeTerm></place><dateIssued encoding="w3cdtf">2000-03</dateIssued><dateCaptured encoding="w3cdtf">1999-04-19</dateCaptured><dateValid encoding="w3cdtf">1999-11-08</dateValid><copyrightDate encoding="w3cdtf">2000</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">1</extent><extent unit="tables">1</extent><extent unit="references">24</extent><extent unit="words">5033</extent></physicalDescription><abstract lang="en">To assess the long‐term outcome following unilateral pallidotomy for advanced Parkinson's disease, we performed nonblinded Core Assessment Program for Intracerebral Transplantations protocol assessments in 10 of the original 15 patients in our pilot study for 4 years following surgery. Although Unified Parkinson's Disease Rating Scale motor examination scores returned to baseline levels at 3 and 4 years, most patients continued to show sustained improvements in contralateral tremor, akinesia, and drug‐induced dyskinesias. Contralateral tremor was absent at 4 years in all seven patients with preoperative tremor. Contralateral “off” arm movement times (averaged for three tasks) decreased by 37% at 1 year and by 30% at 4 years. Contralateral dyskinesia scores improved by 82% at 1 year and by 64% at 4 years. In contrast, after reaching speeds equal to the contralateral side at 1 year, ipsilateral “off” movement times increased by 13% over baseline levels at 4 years. Although most gait and postural stability measures showed modest initial improvement followed by a return to baseline values, “on” stand–walk–sit task performance declined significantly at 4 years. Despite the restriction of our surgeries to one side and the expected natural progression of Parkinson's disease, the results of patient self‐assessments suggest that 4 years after unilateral pallidotomy, most patients continue to experience a quality of life above preoperative levels.</abstract><subject lang="en"><genre>Keywords</genre><topic>Pallidotomy</topic><topic>Stereotaxic surgery</topic><topic>Parkinson's disease</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title><subTitle>Official Journal of the Movement Disorder Society</subTitle></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><subject><genre>article category</genre><topic>Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2000</date><detail type="volume"><caption>vol.</caption><number>15</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>230</start><end>237</end><total>8</total></extent></part></relatedItem><identifier type="istex">9A3F7C52ED1128BB79D36CA07572C1EA5AF6AC77</identifier><identifier type="DOI">10.1002/1531-8257(200003)15:2<230::AID-MDS1005>3.0.CO;2-U</identifier><identifier type="ArticleID">MDS1005</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2000 Movement Disorder Society</accessCondition><recordInfo><recordOrigin>John Wiley & Sons, Inc.</recordOrigin><recordContentSource>WILEY</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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