Pallidotomy improves motor responses and widens the levodopa therapeutic window in Parkinson's disease.
Identifieur interne : 005026 ( Ncbi/Curation ); précédent : 005025; suivant : 005027Pallidotomy improves motor responses and widens the levodopa therapeutic window in Parkinson's disease.
Auteurs : E J Skalabrin [États-Unis] ; E R Laws ; J P BennettSource :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 1998.
English descriptors
- KwdEn :
- Administration, Oral, Aged, Antiparkinson Agents (administration & dosage), Combined Modality Therapy, Dihydroxyphenylalanine (blood), Dominance, Cerebral (drug effects), Dominance, Cerebral (physiology), Female, Gait (drug effects), Globus Pallidus (physiopathology), Globus Pallidus (surgery), Humans, Infusions, Intravenous, Levodopa (administration & dosage), Male, Middle Aged, Motor Skills (drug effects), Motor Skills (physiology), Neurologic Examination (drug effects), Parkinson Disease (physiopathology), Parkinson Disease (surgery), Prolactin (blood), Stereotaxic Techniques.
- MESH :
- chemical , administration & dosage : Antiparkinson Agents, Levodopa.
- chemical , blood : Dihydroxyphenylalanine, Prolactin.
- drug effects : Dominance, Cerebral, Gait, Motor Skills, Neurologic Examination.
- physiology : Dominance, Cerebral, Motor Skills.
- physiopathology : Globus Pallidus, Parkinson Disease.
- surgery : Globus Pallidus, Parkinson Disease.
- Administration, Oral, Aged, Combined Modality Therapy, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Stereotaxic Techniques.
Abstract
Stereotactic posteroventral pallidotomy (PVP) as a treatment for Parkinson's disease (PD) symptoms has been increasingly used in moderate-advanced disease. We examined the pharmacodynamic responses of PD patients to single oral levodopa doses and intravenous levodopa infusions before and after PVP surgery. Nine subjects with advanced PD received a single oral dose and ramped intravenous levodopa infusions before and 3-5 weeks after unilateral PVP. Timed motor tasks, Unified Parkinson's Disease Rating Scale (UPDRS) evaluations, and ordinal dyskinesia rating were performed after oral levodopa and during i.v. levodopa infusions. Serum prolactin and dopa levels were measured during the levodopa infusions. Overall timed motor but not motor UPDRS scores were improved after PVP in both the worst ("off") and best ("on") states. Contralateral but not ipsilateral limb dyskinesias were substantially reduced at all serum (dopa) levels after PVP. Ipsilateral and contralateral timed motor performance at low serum (dopa) levels was improved by PVP. Walking speeds at all serum (dopa) levels were not changed by PVP. Serum prolactin was reduced equally by increasing (dopa) preoperatively and postoperatively. PVP significantly and favorably altered oral and intravenous levodopa pharmacodynamics by improving bilateral limb motor function and contralateral dyskinesia but did not alter walking speed. PVP appears to widen significantly the therapeutic window for levodopa in PD.
DOI: 10.1002/mds.870130504
PubMed: 9756145
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We examined the pharmacodynamic responses of PD patients to single oral levodopa doses and intravenous levodopa infusions before and after PVP surgery. Nine subjects with advanced PD received a single oral dose and ramped intravenous levodopa infusions before and 3-5 weeks after unilateral PVP. Timed motor tasks, Unified Parkinson's Disease Rating Scale (UPDRS) evaluations, and ordinal dyskinesia rating were performed after oral levodopa and during i.v. levodopa infusions. Serum prolactin and dopa levels were measured during the levodopa infusions. Overall timed motor but not motor UPDRS scores were improved after PVP in both the worst ("off") and best ("on") states. Contralateral but not ipsilateral limb dyskinesias were substantially reduced at all serum (dopa) levels after PVP. Ipsilateral and contralateral timed motor performance at low serum (dopa) levels was improved by PVP. Walking speeds at all serum (dopa) levels were not changed by PVP. Serum prolactin was reduced equally by increasing (dopa) preoperatively and postoperatively. PVP significantly and favorably altered oral and intravenous levodopa pharmacodynamics by improving bilateral limb motor function and contralateral dyskinesia but did not alter walking speed. PVP appears to widen significantly the therapeutic window for levodopa in PD.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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