High-frequency stimulation of the globus pallidus internalis in Parkinson's disease: a study of seven cases.
Identifieur interne : 001400 ( PubMed/Checkpoint ); précédent : 001399; suivant : 001401High-frequency stimulation of the globus pallidus internalis in Parkinson's disease: a study of seven cases.
Auteurs : C. Gross [France] ; A. Rougier ; D. Guehl ; T. Boraud ; J. Julien ; B. BioulacSource :
- Journal of neurosurgery [ 0022-3085 ] ; 1997.
English descriptors
- KwdEn :
- Adult, Disease Progression, Dyskinesia, Drug-Induced (etiology), Electric Stimulation Therapy (instrumentation), Electric Stimulation Therapy (methods), Electrodes, Implanted, Follow-Up Studies, Gait (physiology), Globus Pallidus (physiopathology), Globus Pallidus (surgery), Humans, Hypokinesia (surgery), Hypokinesia (therapy), Levodopa (adverse effects), Male, Middle Aged, Movement Disorders (therapy), Muscle Rigidity (surgery), Muscle Rigidity (therapy), Parkinson Disease (etiology), Parkinson Disease (physiopathology), Parkinson Disease (surgery), Parkinson Disease (therapy), Speech Disorders (therapy), Stereotaxic Techniques, Thalamic Nuclei (physiopathology), Treatment Outcome, Tremor (therapy).
- MESH :
- chemical , adverse effects : Levodopa.
- etiology : Dyskinesia, Drug-Induced, Parkinson Disease.
- instrumentation : Electric Stimulation Therapy.
- methods : Electric Stimulation Therapy.
- physiology : Gait.
- physiopathology : Globus Pallidus, Parkinson Disease, Thalamic Nuclei.
- surgery : Globus Pallidus, Hypokinesia, Muscle Rigidity, Parkinson Disease.
- therapy : Hypokinesia, Movement Disorders, Muscle Rigidity, Parkinson Disease, Speech Disorders, Tremor.
- Adult, Disease Progression, Electrodes, Implanted, Follow-Up Studies, Humans, Male, Middle Aged, Stereotaxic Techniques, Treatment Outcome.
Abstract
The effectiveness of ventroposterolateral pallidotomy in the treatment of akinesia and rigidity is not a new discovery and agrees with recent investigations into the pathogenesis of Parkinson's disease, which highlight the role played by the unbridled activity of the subthalamic nucleus (STN) and the consequent overactivity of the globus pallidus internalis (GPi). Because high-frequency stimulation can reversibly incapacitate a nerve structure, we applied stimulation to the same target. Seven patients suffering from severe Parkinson's disease (Stages III-V on the Hoehn and Yahr scale) and, particularly, bradykinesia, rigidity, and levodopa-induced dyskinesias underwent unilateral electrode implantation in the posteroventral GPi. Follow-up evaluation using the regular Unified Parkinson's Disease Rating Scale has been conducted for 1 year in all seven patients, 2 years in five of them, and 3 years in one. In all cases high-frequency stimulation has alleviated akinesia and rigidity and has generally improved gait and speech disturbances. In some cases tremor was attenuated. In a similar manner, the authors observed a marked diminution in levodopa-induced dyskinesias. This could be an excellent primary therapy for younger patients exhibiting severe bradykinesia, rigidity, and levodopa-induced dyskinesias, which would allow therapists to keep ventroposterolateral pallidotomy in reserve as a second weapon.
DOI: 10.3171/jns.1997.87.4.0491
PubMed: 9322838
Affiliations:
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<term>Disease Progression</term>
<term>Dyskinesia, Drug-Induced (etiology)</term>
<term>Electric Stimulation Therapy (instrumentation)</term>
<term>Electric Stimulation Therapy (methods)</term>
<term>Electrodes, Implanted</term>
<term>Follow-Up Studies</term>
<term>Gait (physiology)</term>
<term>Globus Pallidus (physiopathology)</term>
<term>Globus Pallidus (surgery)</term>
<term>Humans</term>
<term>Hypokinesia (surgery)</term>
<term>Hypokinesia (therapy)</term>
<term>Levodopa (adverse effects)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Movement Disorders (therapy)</term>
<term>Muscle Rigidity (surgery)</term>
<term>Muscle Rigidity (therapy)</term>
<term>Parkinson Disease (etiology)</term>
<term>Parkinson Disease (physiopathology)</term>
<term>Parkinson Disease (surgery)</term>
<term>Parkinson Disease (therapy)</term>
<term>Speech Disorders (therapy)</term>
<term>Stereotaxic Techniques</term>
<term>Thalamic Nuclei (physiopathology)</term>
<term>Treatment Outcome</term>
<term>Tremor (therapy)</term>
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<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Levodopa</term>
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<term>Electrodes, Implanted</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
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<front><div type="abstract" xml:lang="en">The effectiveness of ventroposterolateral pallidotomy in the treatment of akinesia and rigidity is not a new discovery and agrees with recent investigations into the pathogenesis of Parkinson's disease, which highlight the role played by the unbridled activity of the subthalamic nucleus (STN) and the consequent overactivity of the globus pallidus internalis (GPi). Because high-frequency stimulation can reversibly incapacitate a nerve structure, we applied stimulation to the same target. Seven patients suffering from severe Parkinson's disease (Stages III-V on the Hoehn and Yahr scale) and, particularly, bradykinesia, rigidity, and levodopa-induced dyskinesias underwent unilateral electrode implantation in the posteroventral GPi. Follow-up evaluation using the regular Unified Parkinson's Disease Rating Scale has been conducted for 1 year in all seven patients, 2 years in five of them, and 3 years in one. In all cases high-frequency stimulation has alleviated akinesia and rigidity and has generally improved gait and speech disturbances. In some cases tremor was attenuated. In a similar manner, the authors observed a marked diminution in levodopa-induced dyskinesias. This could be an excellent primary therapy for younger patients exhibiting severe bradykinesia, rigidity, and levodopa-induced dyskinesias, which would allow therapists to keep ventroposterolateral pallidotomy in reserve as a second weapon.</div>
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<Abstract><AbstractText>The effectiveness of ventroposterolateral pallidotomy in the treatment of akinesia and rigidity is not a new discovery and agrees with recent investigations into the pathogenesis of Parkinson's disease, which highlight the role played by the unbridled activity of the subthalamic nucleus (STN) and the consequent overactivity of the globus pallidus internalis (GPi). Because high-frequency stimulation can reversibly incapacitate a nerve structure, we applied stimulation to the same target. Seven patients suffering from severe Parkinson's disease (Stages III-V on the Hoehn and Yahr scale) and, particularly, bradykinesia, rigidity, and levodopa-induced dyskinesias underwent unilateral electrode implantation in the posteroventral GPi. Follow-up evaluation using the regular Unified Parkinson's Disease Rating Scale has been conducted for 1 year in all seven patients, 2 years in five of them, and 3 years in one. In all cases high-frequency stimulation has alleviated akinesia and rigidity and has generally improved gait and speech disturbances. In some cases tremor was attenuated. In a similar manner, the authors observed a marked diminution in levodopa-induced dyskinesias. This could be an excellent primary therapy for younger patients exhibiting severe bradykinesia, rigidity, and levodopa-induced dyskinesias, which would allow therapists to keep ventroposterolateral pallidotomy in reserve as a second weapon.</AbstractText>
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