Subthalamic Stimulation for Parkinson's Disease
Identifieur interne : 000211 ( France/Analysis ); précédent : 000210; suivant : 000212Subthalamic Stimulation for Parkinson's Disease
Auteurs : Alim-Louis Benabid [France] ; Adnan Koudsié [France] ; Abdelhamid Benazzouz [France] ; Valérie Fraix [France] ; Ahmed Ashraf [France] ; Jean François Le Bas [France] ; Stéphan Chabardes [France] ; Pierre Pollak [France]Source :
- Archives of Medical Research [ 0188-4409 ] ; 1999.
Abstract
Deep brain stimulation by high frequency (HFS) has been developed starting in the thalamic target (Vim) from pragmatic observations and subsequently followed by other targets, such as the subthalamic nucleus (STN) and pallidum as an application of current knowledge from basic preclinical research in neuroscience. The mechanism involved by this neurosurgical approach is not completely solved. For Vim we have formed the hypothesis that HFS induces a jamming of sensory-motor loops but for the STN, from our experimental research in rats we have shown that HFS induces functional inhibition of cell activity in the target nuclei. In our patients the implantation of the stimulation electrodes was carried out stereotactically, under local anesthesia, using ventriculography, MRI, microrecordings and clinical evaluation of the effects of stimulation on rigidity. When the stimulation is turned ON in the STN area a significant decrease in rigidity was determined by the neurologists. Stimulation or even penetration of the electrode may be responsible for transient dyskinesias. The average location of the clinically efficient contact of the chronic stimulating electrodes is statistically located at 5.02 ± 0.71 1/12° of AC-PC in the AP direction, at −1.5 ± 0.66 1/8° of the height of the thalamus in the ventricle direction, with laterality at 11.98 ± 1.12 mm in the lateral direction. The beneficial effects of STN stimulation are significant providing that the electrodes are correctly placed into the target. There is strong improvement of the symptoms of the triad in which akinesia, rigidity, and tremor are reduced on average to 41.6, 48.6, and 27%, respectively, when compared with the previous preoperative level. From our experience, HFS of the STN could be considered the surgical therapy of choice at advanced stages of Parkinson's disease.
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DOI: 10.1016/S0188-4409(00)00077-1
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nucleus (STN) and pallidum as an application of current knowledge from basic preclinical research in neuroscience. The mechanism involved by this neurosurgical approach is not completely solved. For Vim we have formed the hypothesis that HFS induces a jamming of sensory-motor loops but for the STN, from our experimental research in rats we have shown that HFS induces functional inhibition of cell activity in the target nuclei. In our patients the implantation of the stimulation electrodes was carried out stereotactically, under local anesthesia, using ventriculography, MRI, microrecordings and clinical evaluation of the effects of stimulation on rigidity. When the stimulation is turned ON in the STN area a significant decrease in rigidity was determined by the neurologists. Stimulation or even penetration of the electrode may be responsible for transient dyskinesias. The average location of the clinically efficient contact of the chronic stimulating electrodes is statistically located at 5.02 ± 0.71 1/12° of AC-PC in the AP direction, at −1.5 ± 0.66 1/8° of the height of the thalamus in the ventricle direction, with laterality at 11.98 ± 1.12 mm in the lateral direction. The beneficial effects of STN stimulation are significant providing that the electrodes are correctly placed into the target. There is strong improvement of the symptoms of the triad in which akinesia, rigidity, and tremor are reduced on average to 41.6, 48.6, and 27%, respectively, when compared with the previous preoperative level. From our experience, HFS of the STN could be considered the surgical therapy of choice at advanced stages of Parkinson's disease.</div></front></TEI><affiliations><list><country><li>France</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Rhône-Alpes</li></region><settlement><li>Grenoble</li></settlement><orgName><li>Centre hospitalier universitaire Grenoble Alpes</li></orgName></list><tree><country name="France"><noRegion><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name></noRegion><name sortKey="Ashraf, Ahmed" sort="Ashraf, Ahmed" uniqKey="Ashraf A" first="Ahmed" last="Ashraf">Ahmed Ashraf</name><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name><name sortKey="Benazzouz, Abdelhamid" sort="Benazzouz, Abdelhamid" uniqKey="Benazzouz A" first="Abdelhamid" last="Benazzouz">Abdelhamid Benazzouz</name><name sortKey="Chabardes, Stephan" sort="Chabardes, Stephan" uniqKey="Chabardes S" first="Stéphan" last="Chabardes">Stéphan Chabardes</name><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valérie" last="Fraix">Valérie Fraix</name><name sortKey="Koudsie, Adnan" sort="Koudsie, Adnan" uniqKey="Koudsie A" first="Adnan" last="Koudsié">Adnan Koudsié</name><name sortKey="Le Bas, Jean Francois" sort="Le Bas, Jean Francois" uniqKey="Le Bas J" first="Jean François" last="Le Bas">Jean François Le Bas</name><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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