Levodopa-induced dyskinesias treated by pallidotomy
Identifieur interne : 001D06 ( Main/Corpus ); précédent : 001D05; suivant : 001D07Levodopa-induced dyskinesias treated by pallidotomy
Auteurs : Joseph Jankovic ; Eugene Lai ; Lea Ben-Arie ; Joachim K. Krauss ; Robert GrossmanSource :
- Journal of the Neurological Sciences [ 0022-510X ] ; 1999.
Abstract
Pallidotomy has been reported to improve parkinsonian symptoms, but its effects on levodopa-induced dyskinesia (LID) have not been thoroughly examined. We describe here the results of stereotactic, unilateral, posteroventral pallidotomy on LID in 42 patients (22 women), who were followed for up to 9 months. Their mean age was 60.6±9.3 (range: 40–74), age at onset was 46.1±9.1 (range: 24–46), and duration of symptoms was 14.5±5.3 (range: 4–25) years. Three months following pallidotomy, the percent time with dyskinesia decreased from 37.0 to 17.3 (P<0.0001) and the percent time the patients were ‘on’ with dyskinesias decreased even more, from 71.0 to 22.9 (P<0.0001). Furthermore, the number of patients with troublesome (moderate to violent) dyskinesia had decreased from 36 (86%) prior to surgery to only 5 (12%) after surgery. The mean unified Parkinson disease rating scale (UPDRS) scores for LID-related disability and pain decreased from 1.95 to 0.74 (P<0.0001) and from 1.02 to 0.17 (P<0.0001), respectively. Since the pre- and post-pallidotomy daily levodopa dosage remained essentially the same, the improvement in LID could not be attributed to a reduction in levodopa. Surgery-related complications occurred in eight (19%) patients, but none of them had persistent disability as a result of these complications. We conclude that pallidotomy is an effective and safe procedure in the treatment of medically intractable LID.
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DOI: 10.1016/S0022-510X(99)00141-0
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Levodopa-induced dyskinesias treated by pallidotomy</title><author><name sortKey="Jankovic, Joseph" sort="Jankovic, Joseph" uniqKey="Jankovic J" first="Joseph" last="Jankovic">Joseph Jankovic</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: josephj@bcm.tmc.edu</mods:affiliation></affiliation></author><author><name sortKey="Lai, Eugene" sort="Lai, Eugene" uniqKey="Lai E" first="Eugene" last="Lai">Eugene Lai</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation></author><author><name sortKey="Ben Arie, Lea" sort="Ben Arie, Lea" uniqKey="Ben Arie L" first="Lea" last="Ben-Arie">Lea Ben-Arie</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation></author><author><name sortKey="Krauss, Joachim K" sort="Krauss, Joachim K" uniqKey="Krauss J" first="Joachim K" last="Krauss">Joachim K. Krauss</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation></author><author><name sortKey="Grossman, Robert" sort="Grossman, Robert" uniqKey="Grossman R" first="Robert" last="Grossman">Robert Grossman</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:74166943D357F71C7F2F9227D3B7A05742753917</idno><date when="1999" year="1999">1999</date><idno type="doi">10.1016/S0022-510X(99)00141-0</idno><idno type="url">https://api.istex.fr/document/74166943D357F71C7F2F9227D3B7A05742753917/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">001D06</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Levodopa-induced dyskinesias treated by pallidotomy</title><author><name sortKey="Jankovic, Joseph" sort="Jankovic, Joseph" uniqKey="Jankovic J" first="Joseph" last="Jankovic">Joseph Jankovic</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: josephj@bcm.tmc.edu</mods:affiliation></affiliation></author><author><name sortKey="Lai, Eugene" sort="Lai, Eugene" uniqKey="Lai E" first="Eugene" last="Lai">Eugene Lai</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation></author><author><name sortKey="Ben Arie, Lea" sort="Ben Arie, Lea" uniqKey="Ben Arie L" first="Lea" last="Ben-Arie">Lea Ben-Arie</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation></author><author><name sortKey="Krauss, Joachim K" sort="Krauss, Joachim K" uniqKey="Krauss J" first="Joachim K" last="Krauss">Joachim K. Krauss</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation></author><author><name sortKey="Grossman, Robert" sort="Grossman, Robert" uniqKey="Grossman R" first="Robert" last="Grossman">Robert Grossman</name><affiliation><mods:affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of the Neurological Sciences</title><title level="j" type="abbrev">JNS</title><idno type="ISSN">0022-510X</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999">1999</date><biblScope unit="volume">167</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="62">62</biblScope><biblScope unit="page" to="67">67</biblScope></imprint><idno type="ISSN">0022-510X</idno></series><idno type="istex">74166943D357F71C7F2F9227D3B7A05742753917</idno><idno type="DOI">10.1016/S0022-510X(99)00141-0</idno><idno type="PII">S0022-510X(99)00141-0</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-510X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Pallidotomy has been reported to improve parkinsonian symptoms, but its effects on levodopa-induced dyskinesia (LID) have not been thoroughly examined. We describe here the results of stereotactic, unilateral, posteroventral pallidotomy on LID in 42 patients (22 women), who were followed for up to 9 months. Their mean age was 60.6±9.3 (range: 40–74), age at onset was 46.1±9.1 (range: 24–46), and duration of symptoms was 14.5±5.3 (range: 4–25) years. Three months following pallidotomy, the percent time with dyskinesia decreased from 37.0 to 17.3 (P<0.0001) and the percent time the patients were ‘on’ with dyskinesias decreased even more, from 71.0 to 22.9 (P<0.0001). Furthermore, the number of patients with troublesome (moderate to violent) dyskinesia had decreased from 36 (86%) prior to surgery to only 5 (12%) after surgery. The mean unified Parkinson disease rating scale (UPDRS) scores for LID-related disability and pain decreased from 1.95 to 0.74 (P<0.0001) and from 1.02 to 0.17 (P<0.0001), respectively. Since the pre- and post-pallidotomy daily levodopa dosage remained essentially the same, the improvement in LID could not be attributed to a reduction in levodopa. Surgery-related complications occurred in eight (19%) patients, but none of them had persistent disability as a result of these complications. We conclude that pallidotomy is an effective and safe procedure in the treatment of medically intractable LID.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Joseph Jankovic</name><affiliations><json:string>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</json:string><json:string>E-mail: josephj@bcm.tmc.edu</json:string></affiliations></json:item><json:item><name>Eugene Lai</name><affiliations><json:string>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</json:string></affiliations></json:item><json:item><name>Lea Ben-Arie</name><affiliations><json:string>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</json:string></affiliations></json:item><json:item><name>Joachim K Krauss</name><affiliations><json:string>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</json:string></affiliations></json:item><json:item><name>Robert Grossman</name><affiliations><json:string>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Levodopa-induced dyskinesia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson’s disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Pallidotomy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Thalamotomy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Deep brain stimulation</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Pallidotomy has been reported to improve parkinsonian symptoms, but its effects on levodopa-induced dyskinesia (LID) have not been thoroughly examined. We describe here the results of stereotactic, unilateral, posteroventral pallidotomy on LID in 42 patients (22 women), who were followed for up to 9 months. Their mean age was 60.6±9.3 (range: 40–74), age at onset was 46.1±9.1 (range: 24–46), and duration of symptoms was 14.5±5.3 (range: 4–25) years. Three months following pallidotomy, the percent time with dyskinesia decreased from 37.0 to 17.3 (P>0.0001) and the percent time the patients were ‘on’ with dyskinesias decreased even more, from 71.0 to 22.9 (P>0.0001). Furthermore, the number of patients with troublesome (moderate to violent) dyskinesia had decreased from 36 (86%) prior to surgery to only 5 (12%) after surgery. The mean unified Parkinson disease rating scale (UPDRS) scores for LID-related disability and pain decreased from 1.95 to 0.74 (P>0.0001) and from 1.02 to 0.17 (P>0.0001), respectively. Since the pre- and post-pallidotomy daily levodopa dosage remained essentially the same, the improvement in LID could not be attributed to a reduction in levodopa. Surgery-related complications occurred in eight (19%) patients, but none of them had persistent disability as a result of these complications. We conclude that pallidotomy is an effective and safe procedure in the treatment of medically intractable LID.</abstract><qualityIndicators><score>5.764</score><pdfVersion>1.2</pdfVersion><pdfPageSize>598 x 798 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1439</abstractCharCount><pdfWordCount>3184</pdfWordCount><pdfCharCount>20441</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>215</abstractWordCount></qualityIndicators><title>Levodopa-induced dyskinesias treated by pallidotomy</title><pii><json:string>S0022-510X(99)00141-0</json:string></pii><genre><json:string>research-article</json:string></genre><serie><volume>Vol. 2</volume><editor><json:item><name>S. Fahn</name></json:item><json:item><name>C.D. Marsden</name></json:item><json:item><name>D.B. Calne</name></json:item><json:item><name>M. Goldstein</name></json:item></editor><pages><last>164</last><first>153</first></pages><genre></genre><language><json:string>unknown</json:string></language><title>Recent developments in Parkinson’s disease</title></serie><host><volume>167</volume><pii><json:string>S0022-510X(00)X0076-7</json:string></pii><pages><last>67</last><first>62</first></pages><issn><json:string>0022-510X</json:string></issn><issue>1</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><title>Journal of the Neurological Sciences</title><publicationDate>1999</publicationDate></host><categories><wos><json:string>CLINICAL NEUROLOGY</json:string><json:string>NEUROIMAGING</json:string><json:string>NEUROSCIENCES</json:string></wos></categories><publicationDate>1999</publicationDate><copyrightDate>1999</copyrightDate><doi><json:string>10.1016/S0022-510X(99)00141-0</json:string></doi><id>74166943D357F71C7F2F9227D3B7A05742753917</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/74166943D357F71C7F2F9227D3B7A05742753917/fulltext/pdf</uri></json:item><json:item><original>true</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/74166943D357F71C7F2F9227D3B7A05742753917/fulltext/txt</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/74166943D357F71C7F2F9227D3B7A05742753917/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/74166943D357F71C7F2F9227D3B7A05742753917/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Levodopa-induced dyskinesias treated by pallidotomy</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>1999</date></publicationStmt><notesStmt><note type="content">Fig. 1: Histogram showing a significant increase in the percent time ‘on’ (P<0.0001), significant decrease in the total percent time with dyskinesia (P<0.0001), and a significant decrease in the percent waking time ‘on’ with dyskinesia (P<0.0001) in 42 patients 3 months following unilateral posteroventral pallidotomy.</note><note type="content">Fig. 2: Distribution of 42 patients according to severity of dyskinesia showing a shift toward much milder form of dyskinesia 3 months after posteroventral pallidotomy.</note><note type="content">Fig. 3: Limb dyskinesia before and after posteroventral pallidotomy based on anatomic involvement with respect to the side of the lesion, showing a marked improvement in dyskinesia contralateral to the side of lesion and less robust on the side ipsilateral to the lesion.</note><note type="content">Fig. 4: Compared to baseline, there was a significant reduction in the UPDRS dyskinesia-related disability and pain scores at 3, 6 and 9 months following posteroventral pallidotomy (P<0.0001).</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Levodopa-induced dyskinesias treated by pallidotomy</title><author><persName><forename type="first">Joseph</forename><surname>Jankovic</surname></persName><email>josephj@bcm.tmc.edu</email><note type="correspondence"><p>Corresponding author. Tel.: +1-713-798-5998; fax: +1-713-798-6808</p></note><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</affiliation></author><author><persName><forename type="first">Eugene</forename><surname>Lai</surname></persName><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</affiliation></author><author><persName><forename type="first">Lea</forename><surname>Ben-Arie</surname></persName><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</affiliation></author><author><persName><forename type="first">Joachim K</forename><surname>Krauss</surname></persName><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</affiliation></author><author><persName><forename type="first">Robert</forename><surname>Grossman</surname></persName><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</affiliation></author></analytic><monogr><title level="j">Journal of the Neurological Sciences</title><title level="j" type="abbrev">JNS</title><idno type="pISSN">0022-510X</idno><idno type="PII">S0022-510X(00)X0076-7</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999"></date><biblScope unit="volume">167</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="62">62</biblScope><biblScope unit="page" to="67">67</biblScope></imprint></monogr><idno type="istex">74166943D357F71C7F2F9227D3B7A05742753917</idno><idno type="DOI">10.1016/S0022-510X(99)00141-0</idno><idno type="PII">S0022-510X(99)00141-0</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1999</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Pallidotomy has been reported to improve parkinsonian symptoms, but its effects on levodopa-induced dyskinesia (LID) have not been thoroughly examined. We describe here the results of stereotactic, unilateral, posteroventral pallidotomy on LID in 42 patients (22 women), who were followed for up to 9 months. Their mean age was 60.6±9.3 (range: 40–74), age at onset was 46.1±9.1 (range: 24–46), and duration of symptoms was 14.5±5.3 (range: 4–25) years. Three months following pallidotomy, the percent time with dyskinesia decreased from 37.0 to 17.3 (P<0.0001) and the percent time the patients were ‘on’ with dyskinesias decreased even more, from 71.0 to 22.9 (P<0.0001). Furthermore, the number of patients with troublesome (moderate to violent) dyskinesia had decreased from 36 (86%) prior to surgery to only 5 (12%) after surgery. The mean unified Parkinson disease rating scale (UPDRS) scores for LID-related disability and pain decreased from 1.95 to 0.74 (P<0.0001) and from 1.02 to 0.17 (P<0.0001), respectively. Since the pre- and post-pallidotomy daily levodopa dosage remained essentially the same, the improvement in LID could not be attributed to a reduction in levodopa. Surgery-related complications occurred in eight (19%) patients, but none of them had persistent disability as a result of these complications. We conclude that pallidotomy is an effective and safe procedure in the treatment of medically intractable LID.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Levodopa-induced dyskinesia</term></item><item><term>Parkinson’s disease</term></item><item><term>Pallidotomy</term></item><item><term>Thalamotomy</term></item><item><term>Deep brain stimulation</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1999-06-09">Registration</change><change when="1999-06-04">Modified</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="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="gr3"></istex:entity><istex:entity SYSTEM="gr4" NDATA="IMAGE" name="gr4"></istex:entity></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>JNS</jid><aid>6122</aid><ce:pii>S0022-510X(99)00141-0</ce:pii><ce:doi>10.1016/S0022-510X(99)00141-0</ce:doi><ce:copyright type="full-transfer" year="1999">Elsevier Science B.V.</ce:copyright></item-info><head><ce:title>Levodopa-induced dyskinesias treated by pallidotomy</ce:title><ce:author-group><ce:author><ce:given-name>Joseph</ce:given-name><ce:surname>Jankovic</ce:surname><ce:cross-ref refid="CORR1">*</ce:cross-ref><ce:e-address>josephj@bcm.tmc.edu</ce:e-address></ce:author><ce:author><ce:given-name>Eugene</ce:given-name><ce:surname>Lai</ce:surname></ce:author><ce:author><ce:given-name>Lea</ce:given-name><ce:surname>Ben-Arie</ce:surname></ce:author><ce:author><ce:given-name>Joachim K</ce:given-name><ce:surname>Krauss</ce:surname></ce:author><ce:author><ce:given-name>Robert</ce:given-name><ce:surname>Grossman</ce:surname></ce:author><ce:affiliation><ce:textfn>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</ce:textfn></ce:affiliation><ce:correspondence id="CORR1"><ce:label>*</ce:label><ce:text>Corresponding author. Tel.: +1-713-798-5998; fax: +1-713-798-6808</ce:text></ce:correspondence></ce:author-group><ce:date-received day="9" month="2" year="1999"></ce:date-received><ce:date-revised day="4" month="6" year="1999"></ce:date-revised><ce:date-accepted day="9" month="6" year="1999"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>Pallidotomy has been reported to improve parkinsonian symptoms, but its effects on levodopa-induced dyskinesia (LID) have not been thoroughly examined. We describe here the results of stereotactic, unilateral, posteroventral pallidotomy on LID in 42 patients (22 women), who were followed for up to 9 months. Their mean age was 60.6±9.3 (range: 40–74), age at onset was 46.1±9.1 (range: 24–46), and duration of symptoms was 14.5±5.3 (range: 4–25) years. Three months following pallidotomy, the percent time with dyskinesia decreased from 37.0 to 17.3 (<ce:italic>P</ce:italic><0.0001) and the percent time the patients were ‘on’ with dyskinesias decreased even more, from 71.0 to 22.9 (<ce:italic>P</ce:italic><0.0001). Furthermore, the number of patients with troublesome (moderate to violent) dyskinesia had decreased from 36 (86%) prior to surgery to only 5 (12%) after surgery. The mean unified Parkinson disease rating scale (UPDRS) scores for LID-related disability and pain decreased from 1.95 to 0.74 (<ce:italic>P</ce:italic><0.0001) and from 1.02 to 0.17 (<ce:italic>P</ce:italic><0.0001), respectively. Since the pre- and post-pallidotomy daily levodopa dosage remained essentially the same, the improvement in LID could not be attributed to a reduction in levodopa. Surgery-related complications occurred in eight (19%) patients, but none of them had persistent disability as a result of these complications. We conclude that pallidotomy is an effective and safe procedure in the treatment of medically intractable LID.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>Levodopa-induced dyskinesia</ce:text></ce:keyword><ce:keyword><ce:text>Parkinson’s disease</ce:text></ce:keyword><ce:keyword><ce:text>Pallidotomy</ce:text></ce:keyword><ce:keyword><ce:text>Thalamotomy</ce:text></ce:keyword><ce:keyword><ce:text>Deep brain stimulation</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Levodopa-induced dyskinesias treated by pallidotomy</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Levodopa-induced dyskinesias treated by pallidotomy</title></titleInfo><name type="personal"><namePart type="given">Joseph</namePart><namePart type="family">Jankovic</namePart><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</affiliation><affiliation>E-mail: josephj@bcm.tmc.edu</affiliation><description>Corresponding author. Tel.: +1-713-798-5998; fax: +1-713-798-6808</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Eugene</namePart><namePart type="family">Lai</namePart><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lea</namePart><namePart type="family">Ben-Arie</namePart><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Joachim K</namePart><namePart type="family">Krauss</namePart><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Robert</namePart><namePart type="family">Grossman</namePart><affiliation>Baylor College of Medicine, Dir. of Parkinson’s Disease Ctr. and Movement Disorders Ctr., 6550 Fannin #1801, Houston, TX 77030, USA</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">1999-06-09</dateValid><dateModified encoding="w3cdtf">1999-06-04</dateModified><copyrightDate encoding="w3cdtf">1999</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">Pallidotomy has been reported to improve parkinsonian symptoms, but its effects on levodopa-induced dyskinesia (LID) have not been thoroughly examined. We describe here the results of stereotactic, unilateral, posteroventral pallidotomy on LID in 42 patients (22 women), who were followed for up to 9 months. Their mean age was 60.6±9.3 (range: 40–74), age at onset was 46.1±9.1 (range: 24–46), and duration of symptoms was 14.5±5.3 (range: 4–25) years. Three months following pallidotomy, the percent time with dyskinesia decreased from 37.0 to 17.3 (P<0.0001) and the percent time the patients were ‘on’ with dyskinesias decreased even more, from 71.0 to 22.9 (P<0.0001). Furthermore, the number of patients with troublesome (moderate to violent) dyskinesia had decreased from 36 (86%) prior to surgery to only 5 (12%) after surgery. The mean unified Parkinson disease rating scale (UPDRS) scores for LID-related disability and pain decreased from 1.95 to 0.74 (P<0.0001) and from 1.02 to 0.17 (P<0.0001), respectively. Since the pre- and post-pallidotomy daily levodopa dosage remained essentially the same, the improvement in LID could not be attributed to a reduction in levodopa. Surgery-related complications occurred in eight (19%) patients, but none of them had persistent disability as a result of these complications. We conclude that pallidotomy is an effective and safe procedure in the treatment of medically intractable LID.</abstract><note type="content">Fig. 1: Histogram showing a significant increase in the percent time ‘on’ (P<0.0001), significant decrease in the total percent time with dyskinesia (P<0.0001), and a significant decrease in the percent waking time ‘on’ with dyskinesia (P<0.0001) in 42 patients 3 months following unilateral posteroventral pallidotomy.</note><note type="content">Fig. 2: Distribution of 42 patients according to severity of dyskinesia showing a shift toward much milder form of dyskinesia 3 months after posteroventral pallidotomy.</note><note type="content">Fig. 3: Limb dyskinesia before and after posteroventral pallidotomy based on anatomic involvement with respect to the side of the lesion, showing a marked improvement in dyskinesia contralateral to the side of lesion and less robust on the side ipsilateral to the lesion.</note><note type="content">Fig. 4: Compared to baseline, there was a significant reduction in the UPDRS dyskinesia-related disability and pain scores at 3, 6 and 9 months following posteroventral pallidotomy (P<0.0001).</note><subject><genre>Keywords</genre><topic>Levodopa-induced dyskinesia</topic><topic>Parkinson’s disease</topic><topic>Pallidotomy</topic><topic>Thalamotomy</topic><topic>Deep brain stimulation</topic></subject><relatedItem type="host"><titleInfo><title>Journal of the Neurological Sciences</title></titleInfo><titleInfo type="abbreviated"><title>JNS</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">19990801</dateIssued></originInfo><identifier type="ISSN">0022-510X</identifier><identifier type="PII">S0022-510X(00)X0076-7</identifier><part><date>19990801</date><detail type="volume"><number>167</number><caption>vol.</caption></detail><detail type="issue"><number>1</number><caption>no.</caption></detail><extent unit="issue pages"><start>1</start><end>78</end></extent><extent unit="pages"><start>62</start><end>67</end></extent></part></relatedItem><identifier type="istex">74166943D357F71C7F2F9227D3B7A05742753917</identifier><identifier type="DOI">10.1016/S0022-510X(99)00141-0</identifier><identifier type="PII">S0022-510X(99)00141-0</identifier><accessCondition type="use and reproduction" contentType="">© 1999Elsevier Science B.V.</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Elsevier Science B.V., ©1999</recordOrigin></recordInfo></mods></metadata><enrichments><istex:catWosTEI uri="https://api.istex.fr/document/74166943D357F71C7F2F9227D3B7A05742753917/enrichments/catWos"><teiHeader><profileDesc><textClass><classCode scheme="WOS">CLINICAL NEUROLOGY</classCode><classCode scheme="WOS">NEUROIMAGING</classCode><classCode scheme="WOS">NEUROSCIENCES</classCode></textClass></profileDesc></teiHeader></istex:catWosTEI></enrichments></istex></record>Pour manipuler ce document sous Unix (Dilib)
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