Lesion therapy for Parkinson's disease and other movement disorders: Update and controversies
Identifieur interne : 003C70 ( Main/Exploration ); précédent : 003C69; suivant : 003C71Lesion therapy for Parkinson's disease and other movement disorders: Update and controversies
Auteurs : Michael S. Okun [États-Unis] ; Jerrold L. Vitek [États-Unis]Source :
- Movement Disorders [ 0885-3185 ] ; 2004-04.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
- Electric Stimulation Therapy (instrumentation), Globus Pallidus (surgery), Humans, Lesion therapy, Microelectrodes, Movement Disorders (epidemiology), Nervous system diseases, Neurosurgical Procedures (instrumentation), Parkinson Disease (epidemiology), Parkinson Disease (therapy), Parkinson disease, Parkinson's disease, Subthalamic Nucleus (surgery), Thalamus (surgery), Therapy, Treatment, deep brain stimulation, pallidotomy, thalamotomy.
- MESH :
- epidemiology : Movement Disorders, Parkinson Disease.
- instrumentation : Electric Stimulation Therapy, Neurosurgical Procedures.
- surgery : Globus Pallidus, Subthalamic Nucleus, Thalamus.
- therapy : Parkinson Disease.
- Humans, Microelectrodes.
Abstract
An analysis of the international literature on lesioning for movement disorders was undertaken to review lesion therapy for Parkinson's disease (PD) and other movement disorders and to highlight important controversies surrounding this surgical technique. Lesions have been placed throughout the neuraxis with varying approaches and success. Our understanding of the pathophysiological basis underlying the development of PD and other movement disorders has led to a better understanding of why lesioning certain portions of the nervous system should improve motor function. Advances in imaging technology and electrophysiological techniques used for localization of brain structures, such as microelectrode mapping, have improved the ability to accurately identify and lesion target structures deep in the brain. This improvement has led to an increase in the degree and consistency of clinical benefit. The major controversies in lesion therapy include: (1) which target for which disorder; (2) determination of the optimal lesion site and whether the external globus pallidus (GPe) should be included in the pallidotomy lesion for PD; (3) determination of the size of the lesion; (4) whether bilateral lesions can be placed without the high incidence of side effects reported by some investigators; (5) whether microelectrodes aid in the ability to improve clinical outcomes or increase the risk of side effects by making multiple microelectrode penetrations; (6) whether the subthalamic nucleus (STN) should be explored further as a lesioning target; and (7) whether lesioning should be abandoned entirely in favor of deep brain stimulation (DBS). Many important questions and controversies regarding lesion therapy remain unanswered. It is unlikely given the pro‐DBS environment that these questions will be answered in the near future. We should, however, be careful not to abandon an effective therapy before fully exploring through randomized trials the relative effect of different surgical approaches for the treatment of patients with movement disorders. © 2004 Movement Disorder Society
Url:
DOI: 10.1002/mds.20037
Affiliations:
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Le document en format XML
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<front><div type="abstract" xml:lang="en">An analysis of the international literature on lesioning for movement disorders was undertaken to review lesion therapy for Parkinson's disease (PD) and other movement disorders and to highlight important controversies surrounding this surgical technique. Lesions have been placed throughout the neuraxis with varying approaches and success. Our understanding of the pathophysiological basis underlying the development of PD and other movement disorders has led to a better understanding of why lesioning certain portions of the nervous system should improve motor function. Advances in imaging technology and electrophysiological techniques used for localization of brain structures, such as microelectrode mapping, have improved the ability to accurately identify and lesion target structures deep in the brain. This improvement has led to an increase in the degree and consistency of clinical benefit. The major controversies in lesion therapy include: (1) which target for which disorder; (2) determination of the optimal lesion site and whether the external globus pallidus (GPe) should be included in the pallidotomy lesion for PD; (3) determination of the size of the lesion; (4) whether bilateral lesions can be placed without the high incidence of side effects reported by some investigators; (5) whether microelectrodes aid in the ability to improve clinical outcomes or increase the risk of side effects by making multiple microelectrode penetrations; (6) whether the subthalamic nucleus (STN) should be explored further as a lesioning target; and (7) whether lesioning should be abandoned entirely in favor of deep brain stimulation (DBS). Many important questions and controversies regarding lesion therapy remain unanswered. It is unlikely given the pro‐DBS environment that these questions will be answered in the near future. We should, however, be careful not to abandon an effective therapy before fully exploring through randomized trials the relative effect of different surgical approaches for the treatment of patients with movement disorders. © 2004 Movement Disorder Society</div>
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