Bilateral Implantation of Centromedian‐Parafascicularis Complex and GPi: A New Combination of Unconventional Targets for Deep Brain Stimulation in Severe Parkinson Disease
Identifieur interne : 001349 ( Main/Exploration ); précédent : 001348; suivant : 001350Bilateral Implantation of Centromedian‐Parafascicularis Complex and GPi: A New Combination of Unconventional Targets for Deep Brain Stimulation in Severe Parkinson Disease
Auteurs : Paolo Mazzone [Italie] ; Fabrizio Stocchi [Italie] ; Salvatore Galati [Italie] ; Angelo Insola [Italie] ; Maria Grazia Altibrandi [Italie] ; Nicola Modugno [Italie] ; Domenicantonio Tropepi [Italie] ; Livia Brusa [Italie] ; Alessandro Stefani [Italie]Source :
- Neuromodulation: Technology at the Neural Interface [ 1094-7159 ] ; 2006-07.
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Abstract
Objectives. Traditional deep brain stimulation (DBS) at the subthalamic nucleus (STN) has proved to be efficacious on core Parkinsonian symptoms. However, very disabling l‐dopa–induced abnormal involuntary movements (AIMs) and axial signs are slightly affected, suggesting that we target less conventional targets. Our candidates for DBS were the globus pallidus internus (GPi) plus the intralaminar thalamic complex (Pf or CM), given its extensive functional links with basal ganglia nuclei. Materials and Methods. The routine utilization of our innovative stereotactic apparatus allows us to implant, at the same time, both the CM‐Pf complex together with the GPi in six Parkinson disease patients. Both intraoperative and postoperative neurophysiologic assessments helped us recognize functional subregions while optimizing implantation of electrodes. Unified Parkinson disease rating scale (UPDRS) motor scores, AIMs, and freezing were carefully blindly evaluated for each condition. Results. A significant amelioration of UPDRS scores was achieved by simultaneous activation of both targets. CM‐Pf activation was only slightly effective in reducing rigidity and akinesia, but more efficacious on freezing. Not surprisingly, AIMs were peculiarly decreased by the activation of the permanent electro‐catheter in the posteroventral GPi. Conclusions. These findings confirm that, in selected patients, it is conceivable to target structures other than the conventional STN in order to maximize clinical benefit.
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DOI: 10.1111/j.1525-1403.2006.00063.x
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Traditional deep brain stimulation (DBS) at the subthalamic nucleus (STN) has proved to be efficacious on core Parkinsonian symptoms. However, very disabling l‐dopa–induced abnormal involuntary movements (AIMs) and axial signs are slightly affected, suggesting that we target less conventional targets. Our candidates for DBS were the globus pallidus internus (GPi) plus the intralaminar thalamic complex (Pf or CM), given its extensive functional links with basal ganglia nuclei. Materials and Methods. The routine utilization of our innovative stereotactic apparatus allows us to implant, at the same time, both the CM‐Pf complex together with the GPi in six Parkinson disease patients. Both intraoperative and postoperative neurophysiologic assessments helped us recognize functional subregions while optimizing implantation of electrodes. Unified Parkinson disease rating scale (UPDRS) motor scores, AIMs, and freezing were carefully blindly evaluated for each condition. Results. A significant amelioration of UPDRS scores was achieved by simultaneous activation of both targets. CM‐Pf activation was only slightly effective in reducing rigidity and akinesia, but more efficacious on freezing. Not surprisingly, AIMs were peculiarly decreased by the activation of the permanent electro‐catheter in the posteroventral GPi. Conclusions. These findings confirm that, in selected patients, it is conceivable to target structures other than the conventional STN in order to maximize clinical benefit.</div></front></TEI><affiliations><list><country><li>Italie</li></country><region><li>Latium</li></region><settlement><li>Rome</li></settlement></list><tree><country name="Italie"><region name="Latium"><name sortKey="Mazzone, Paolo" sort="Mazzone, Paolo" uniqKey="Mazzone P" first="Paolo" last="Mazzone">Paolo Mazzone</name></region><name sortKey="Altibrandi, Maria Grazia" sort="Altibrandi, Maria Grazia" uniqKey="Altibrandi M" first="Maria Grazia" last="Altibrandi">Maria Grazia Altibrandi</name><name sortKey="Brusa, Livia" sort="Brusa, Livia" uniqKey="Brusa L" first="Livia" last="Brusa">Livia Brusa</name><name sortKey="Galati, Salvatore" sort="Galati, Salvatore" uniqKey="Galati S" first="Salvatore" last="Galati">Salvatore Galati</name><name sortKey="Insola, Angelo" sort="Insola, Angelo" uniqKey="Insola A" first="Angelo" last="Insola">Angelo Insola</name><name sortKey="Modugno, Nicola" sort="Modugno, Nicola" uniqKey="Modugno N" first="Nicola" last="Modugno">Nicola Modugno</name><name sortKey="Stefani, Alessandro" sort="Stefani, Alessandro" uniqKey="Stefani A" first="Alessandro" last="Stefani">Alessandro Stefani</name><name sortKey="Stefani, Alessandro" sort="Stefani, Alessandro" uniqKey="Stefani A" first="Alessandro" last="Stefani">Alessandro Stefani</name><name sortKey="Stocchi, Fabrizio" sort="Stocchi, Fabrizio" uniqKey="Stocchi F" first="Fabrizio" last="Stocchi">Fabrizio Stocchi</name><name sortKey="Tropepi, Domenicantonio" sort="Tropepi, Domenicantonio" uniqKey="Tropepi D" first="Domenicantonio" last="Tropepi">Domenicantonio Tropepi</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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