Subthalamic Stimulation for Parkinson's Disease
Identifieur interne : 001420 ( Main/Corpus ); précédent : 001419; suivant : 001421Subthalamic Stimulation for Parkinson's Disease
Auteurs : Alim-Louis Benabid ; Adnan Koudsié ; Abdelhamid Benazzouz ; Valérie Fraix ; Ahmed Ashraf ; Jean François Le Bas ; Stéphan Chabardes ; Pierre PollakSource :
- 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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Benazzouz</name><affiliation><mods:affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valérie" last="Fraix">Valérie Fraix</name><affiliation><mods:affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Ashraf, Ahmed" sort="Ashraf, Ahmed" uniqKey="Ashraf A" first="Ahmed" last="Ashraf">Ahmed Ashraf</name><affiliation><mods:affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</mods:affiliation></affiliation></author><author><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><affiliation><mods:affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Chabardes, Stephan" sort="Chabardes, Stephan" uniqKey="Chabardes S" first="Stéphan" last="Chabardes">Stéphan Chabardes</name><affiliation><mods:affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name><affiliation><mods:affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Archives of Medical Research</title><title level="j" type="abbrev">ARCMED</title><idno type="ISSN">0188-4409</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999">1999</date><biblScope unit="volume">31</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="282">282</biblScope><biblScope unit="page" to="289">289</biblScope></imprint><idno type="ISSN">0188-4409</idno></series><idno type="istex">62245294704D7717D2CB9E328CEE5987CC5C549C</idno><idno type="DOI">10.1016/S0188-4409(00)00077-1</idno><idno type="PII">S0188-4409(00)00077-1</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0188-4409</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Alim-Louis Benabid</name><affiliations><json:string>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</json:string><json:string>E-mail: alim-louis.benabid@ujf-grenoble.fr</json:string></affiliations></json:item><json:item><name>Adnan Koudsié</name><affiliations><json:string>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</json:string></affiliations></json:item><json:item><name>Abdelhamid Benazzouz</name><affiliations><json:string>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</json:string></affiliations></json:item><json:item><name>Valérie Fraix</name><affiliations><json:string>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</json:string></affiliations></json:item><json:item><name>Ahmed Ashraf</name><affiliations><json:string>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</json:string></affiliations></json:item><json:item><name>Jean François Le Bas</name><affiliations><json:string>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</json:string></affiliations></json:item><json:item><name>Stéphan Chabardes</name><affiliations><json:string>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</json:string></affiliations></json:item><json:item><name>Pierre Pollak</name><affiliations><json:string>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Chronic electrical stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Alternative surgical treatment</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>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.</abstract><qualityIndicators><score>8</score><pdfVersion>1.2</pdfVersion><pdfPageSize>594 x 792 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>4</keywordCount><abstractCharCount>1855</abstractCharCount><pdfWordCount>6508</pdfWordCount><pdfCharCount>39667</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>284</abstractWordCount></qualityIndicators><title>Subthalamic Stimulation for Parkinson's Disease</title><pii><json:string>S0188-4409(00)00077-1</json:string></pii><genre><json:string>research-article</json:string></genre><host><volume>31</volume><pii><json:string>S0188-4409(00)X0009-4</json:string></pii><pages><last>289</last><first>282</first></pages><issn><json:string>0188-4409</json:string></issn><issue>3</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><title>Archives of Medical Research</title><publicationDate>2000</publicationDate></host><categories><wos><json:string>MEDICINE, RESEARCH & EXPERIMENTAL</json:string></wos></categories><publicationDate>1999</publicationDate><copyrightDate>2000</copyrightDate><doi><json:string>10.1016/S0188-4409(00)00077-1</json:string></doi><id>62245294704D7717D2CB9E328CEE5987CC5C549C</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/62245294704D7717D2CB9E328CEE5987CC5C549C/fulltext/pdf</uri></json:item><json:item><original>true</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/62245294704D7717D2CB9E328CEE5987CC5C549C/fulltext/txt</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/62245294704D7717D2CB9E328CEE5987CC5C549C/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/62245294704D7717D2CB9E328CEE5987CC5C549C/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Subthalamic Stimulation for Parkinson's Disease</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>2000</date></publicationStmt><notesStmt><note>99/209</note><note type="content">Section title: Original articles</note><note type="content">Figure 1: Computer drawing of the position of STN electrodes. The active contact (one out of four) is chosen on the basis of optimal clinical result and is represented from control x-rays taken at the end of the implantation session and digitalized in normalized coordinates. (A) Schemes represent the lateral view, the horizontal axis represents the distance from PC in 1/12° of AC-PC length, and vertical axis is in 1/8° of the height of the thalamus. The STN target extends over the middle third of AC-PC below the line. (B) Schemes represent the antero-posterior view, laterality is in mm, and vertical axis is in 1/8° of the height of the thalamus. Average laterality is 12 mm and the STN extends from 11–13 mm. (C) Schemes projecting the image of the average target (black square) and (D) the limits of the standard deviations around the average target (rectangle). On the lower lateral view is represented the trajectory of which the theoretical angle on AC-PC is 63.57° ± 2.34 on the basis of the Guiot scheme, and is actually 63.11° ± 3.87 on the right side and 62.81° ± 4.59 on the left side</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Subthalamic Stimulation for Parkinson's Disease</title><author><persName><forename type="first">Alim-Louis</forename><surname>Benabid</surname></persName><email>alim-louis.benabid@ujf-grenoble.fr</email><note type="biography">Address reprint requests to: A.L. Benabid, MD, PhD, u. 318 INSERM-UJFG, Pavillon B, Centre Hospitalier Universitaire, BP 217, F38043, Grenoble, Cedex 9, France. Tel.: (+33) (047) 676-5625; FAX: (+33) (047) 676-5619</note><affiliation>Address reprint requests to: A.L. Benabid, MD, PhD, u. 318 INSERM-UJFG, Pavillon B, Centre Hospitalier Universitaire, BP 217, F38043, Grenoble, Cedex 9, France. Tel.: (+33) (047) 676-5625; FAX: (+33) (047) 676-5619</affiliation><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation></author><author><persName><forename type="first">Adnan</forename><surname>Koudsié</surname></persName><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation></author><author><persName><forename type="first">Abdelhamid</forename><surname>Benazzouz</surname></persName><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation></author><author><persName><forename type="first">Valérie</forename><surname>Fraix</surname></persName><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation></author><author><persName><forename type="first">Ahmed</forename><surname>Ashraf</surname></persName><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation></author><author><persName><forename type="first">Jean François</forename><surname>Le Bas</surname></persName><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation></author><author><persName><forename type="first">Stéphan</forename><surname>Chabardes</surname></persName><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation></author><author><persName><forename type="first">Pierre</forename><surname>Pollak</surname></persName><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation></author></analytic><monogr><title level="j">Archives of Medical Research</title><title level="j" type="abbrev">ARCMED</title><idno type="pISSN">0188-4409</idno><idno type="PII">S0188-4409(00)X0009-4</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999"></date><biblScope unit="volume">31</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="282">282</biblScope><biblScope unit="page" to="289">289</biblScope></imprint></monogr><idno type="istex">62245294704D7717D2CB9E328CEE5987CC5C549C</idno><idno type="DOI">10.1016/S0188-4409(00)00077-1</idno><idno type="PII">S0188-4409(00)00077-1</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2000</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>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.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Chronic electrical stimulation</term></item><item><term>Subthalamic nucleus</term></item><item><term>Alternative surgical treatment</term></item><item><term>Parkinson's disease</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1999-11-30">Registration</change><change when="1999">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: ce:floats; body; tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"><istex:entity SYSTEM="gr1b" NDATA="IMAGE" name="gr1b"></istex:entity><istex:entity SYSTEM="gr1a" NDATA="IMAGE" name="gr1a"></istex:entity><istex:entity SYSTEM="gr1c" NDATA="IMAGE" name="gr1c"></istex:entity><istex:entity SYSTEM="gr1d" NDATA="IMAGE" name="gr1d"></istex:entity></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>ARCMED</jid><aid>152</aid><ce:pii>S0188-4409(00)00077-1</ce:pii><ce:doi>10.1016/S0188-4409(00)00077-1</ce:doi><ce:copyright type="society" year="2000">IMSS</ce:copyright></item-info><head><ce:dochead><ce:textfn>Original articles</ce:textfn></ce:dochead><ce:title>Subthalamic Stimulation for Parkinson's Disease</ce:title><ce:author-group><ce:author><ce:given-name>Alim-Louis</ce:given-name><ce:surname>Benabid</ce:surname><ce:cross-ref refid="CORR1">*</ce:cross-ref><ce:e-address>alim-louis.benabid@ujf-grenoble.fr</ce:e-address></ce:author><ce:author><ce:given-name>Adnan</ce:given-name><ce:surname>Koudsié</ce:surname></ce:author><ce:author><ce:given-name>Abdelhamid</ce:given-name><ce:surname>Benazzouz</ce:surname></ce:author><ce:author><ce:given-name>Valérie</ce:given-name><ce:surname>Fraix</ce:surname></ce:author><ce:author><ce:given-name>Ahmed</ce:given-name><ce:surname>Ashraf</ce:surname></ce:author><ce:author><ce:given-name>Jean François</ce:given-name><ce:surname>Le Bas</ce:surname></ce:author><ce:author><ce:given-name>Stéphan</ce:given-name><ce:surname>Chabardes</ce:surname></ce:author><ce:author><ce:given-name>Pierre</ce:given-name><ce:surname>Pollak</ce:surname></ce:author><ce:affiliation><ce:textfn>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</ce:textfn></ce:affiliation><ce:correspondence id="CORR1"><ce:label>*</ce:label><ce:text>Address reprint requests to: A.L. Benabid, MD, PhD, u. 318 INSERM-UJFG, Pavillon B, Centre Hospitalier Universitaire, BP 217, F38043, Grenoble, Cedex 9, France. Tel.: (+33) (047) 676-5625; FAX: (+33) (047) 676-5619</ce:text></ce:correspondence></ce:author-group><ce:date-received day="25" month="11" year="1999"></ce:date-received><ce:date-accepted day="30" month="11" year="1999"></ce:date-accepted><ce:miscellaneous>99/209</ce:miscellaneous><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>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.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>Chronic electrical stimulation</ce:text></ce:keyword><ce:keyword><ce:text>Subthalamic nucleus</ce:text></ce:keyword><ce:keyword><ce:text>Alternative surgical treatment</ce:text></ce:keyword><ce:keyword><ce:text>Parkinson's disease</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Subthalamic Stimulation for Parkinson's Disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Subthalamic Stimulation for Parkinson's Disease</title></titleInfo><name type="personal"><namePart type="given">Alim-Louis</namePart><namePart type="family">Benabid</namePart><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation><affiliation>E-mail: alim-louis.benabid@ujf-grenoble.fr</affiliation><description>Address reprint requests to: A.L. Benabid, MD, PhD, u. 318 INSERM-UJFG, Pavillon B, Centre Hospitalier Universitaire, BP 217, F38043, Grenoble, Cedex 9, France. Tel.: (+33) (047) 676-5625; FAX: (+33) (047) 676-5619</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Adnan</namePart><namePart type="family">Koudsié</namePart><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Abdelhamid</namePart><namePart type="family">Benazzouz</namePart><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Valérie</namePart><namePart type="family">Fraix</namePart><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ahmed</namePart><namePart type="family">Ashraf</namePart><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jean François</namePart><namePart type="family">Le Bas</namePart><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Stéphan</namePart><namePart type="family">Chabardes</namePart><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pierre</namePart><namePart type="family">Pollak</namePart><affiliation>Department of Neurosciences, University Hospital of Grenoble, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1999</dateIssued><dateValid encoding="w3cdtf">1999-11-30</dateValid><copyrightDate encoding="w3cdtf">2000</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">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.</abstract><note>99/209</note><note type="content">Section title: Original articles</note><note type="content">Figure 1: Computer drawing of the position of STN electrodes. The active contact (one out of four) is chosen on the basis of optimal clinical result and is represented from control x-rays taken at the end of the implantation session and digitalized in normalized coordinates. (A) Schemes represent the lateral view, the horizontal axis represents the distance from PC in 1/12° of AC-PC length, and vertical axis is in 1/8° of the height of the thalamus. The STN target extends over the middle third of AC-PC below the line. (B) Schemes represent the antero-posterior view, laterality is in mm, and vertical axis is in 1/8° of the height of the thalamus. Average laterality is 12 mm and the STN extends from 11–13 mm. (C) Schemes projecting the image of the average target (black square) and (D) the limits of the standard deviations around the average target (rectangle). On the lower lateral view is represented the trajectory of which the theoretical angle on AC-PC is 63.57° ± 2.34 on the basis of the Guiot scheme, and is actually 63.11° ± 3.87 on the right side and 62.81° ± 4.59 on the left side</note><subject><genre>Keywords</genre><topic>Chronic electrical stimulation</topic><topic>Subthalamic nucleus</topic><topic>Alternative surgical treatment</topic><topic>Parkinson's disease</topic></subject><relatedItem type="host"><titleInfo><title>Archives of Medical Research</title></titleInfo><titleInfo type="abbreviated"><title>ARCMED</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">200005</dateIssued></originInfo><identifier type="ISSN">0188-4409</identifier><identifier type="PII">S0188-4409(00)X0009-4</identifier><part><date>200005</date><detail type="volume"><number>31</number><caption>vol.</caption></detail><detail type="issue"><number>3</number><caption>no.</caption></detail><extent unit="issue pages"><start>231</start><end>328</end></extent><extent unit="pages"><start>282</start><end>289</end></extent></part></relatedItem><identifier type="istex">62245294704D7717D2CB9E328CEE5987CC5C549C</identifier><identifier type="DOI">10.1016/S0188-4409(00)00077-1</identifier><identifier type="PII">S0188-4409(00)00077-1</identifier><accessCondition type="use and reproduction" contentType="">© 2000IMSS</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>IMSS, ©2000</recordOrigin></recordInfo></mods></metadata><enrichments><istex:catWosTEI uri="https://api.istex.fr/document/62245294704D7717D2CB9E328CEE5987CC5C549C/enrichments/catWos"><teiHeader><profileDesc><textClass><classCode scheme="WOS">MEDICINE, RESEARCH & EXPERIMENTAL</classCode></textClass></profileDesc></teiHeader></istex:catWosTEI></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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