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Pallidal Stimulation in Parkinson's Disease Patients with a Prior Unilateral Pallidotomy

Published online by Cambridge University Press:  18 September 2015

Nestor Gálvez-Jiménez ,
Andres Lozano ,
Ronald Tasker ,
Janice Duff ,
William Hutchison  and
Anthony E. Lang
Nestor Gálvez-Jiménez
Affiliation:
The Morton and Gloria Shulman Movement Disorders Centre, Division of Neurology and Playfair Neurosciences Unit, The Toronto Hospital and The University of Toronto, Toronto, Ontario, Canada.
Andres Lozano
Affiliation:
Division of Neurosurgery, The Toronto Hospital and The University of Toronto, Toronto, Ontario, Canada.
Ronald Tasker
Affiliation:
Division of Neurosurgery, The Toronto Hospital and The University of Toronto, Toronto, Ontario, Canada.
Janice Duff
Affiliation:
The Morton and Gloria Shulman Movement Disorders Centre, Division of Neurology and Playfair Neurosciences Unit, The Toronto Hospital and The University of Toronto, Toronto, Ontario, Canada.
William Hutchison
Affiliation:
Department of Physiology, The Toronto Hospital and The University of Toronto, Toronto, Ontario, Canada.
Anthony E. Lang*
Affiliation:
The Morton and Gloria Shulman Movement Disorders Centre, Division of Neurology and Playfair Neurosciences Unit, The Toronto Hospital and The University of Toronto, Toronto, Ontario, Canada.
*
The Morton and Gloria Shulman Movement Disorders Centre, The Toronto Hospital, 399 Bathurst Street, MP11-306, Toronto, Ontario, Canada M5T 2S8
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Abstract:

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Objective:

To evaluate, in a double-blind fashion, the efficacy of deep brain stimulation of the internal segment of the globus pallidus (GPi) contralateral to a previous unilateral medial pallidotomy (MP).

Methods:

This pilot study involved 4 patients with a previous MP and one previously unoperated patient unable to tolerate any antiparkinsonian drugs. One of the patients with a prior unilateral MP had two electrodes implanted in the contralateral side, one in GPi and one in Vim thalamus. Detailed neurologic assessments were performed after overnight drug withdrawal and in the drug “on” state at baseline, 1 week and 3 months (in all), and 9 and 12 months (one) with patients and evaluators blinded to the status of stimulation.

Results:

GPi stimulation resulted in improvements in “off-period” contralateral bradykinesia, rigidity and tremor in all patients. Dyskinesias and freezing episodes were ameliorated in one patient each but dyskinesias were transiently induced in another. The patient with GPi+Vim electrodes had complete resolution of contralateral tremor with thalamic stimulation but less benefit from acute GPi stimulation. One patient experienced a single seizure one week post-op and no other surgical complications were observed.

Conclusions:

Deep brain stimulation can be applied safely and effectively in patients who have already had a pallidotomy on the contralateral side. The effect of stimulation at different sites on different symptom profiles and levodopa-induced dyskinesias requires further evaluation.

Résumé:

RÉSUMÉ: But:

D'évaluer, par une étude à double insu, l'efficacité d'une stimulation du segment interne du globus pal-lidus (GPi) contralatéral à une pallidotomie médiale (PM) unilatérale subie antérieurement.

Méthodes:

Cette étude pilote porte sur 4 patients ayant subi une PM antérieurement et un patient qui n'avait pas subi de chirurgie et qui ne tolérait aucun médicament antiparkinsonien. Chez un des patients qui avait subi une PM unilatérale, on a implanté deux électrodes du côté opposé, une dans le GPi et une dans le thalamus Vim. On a procédé à une évaluation neurologique détaillée alors que les patients n'avaient pas reçu leur médication depuis la veille et sous médication, en période "on", à 1 semaine, 3 mois (chez tous), 9 et 12 mois (chez un), la stimulation étant faite à l'insu des patients et des évaluateurs.

Résultats:

La stimulation GPi a provoqué une amélioration dans les périodes "off de la bradykinésie, de la rigidité et du tremblement contralatéral chez tous les patients. Les dyskinésies ont été améliorées chez un patient et les épisodes de blocage chez un autre, mais des dyskinésies ont été induites de façon transitoire chez un autre. Le patient chez qui on avait implanté des électrodes GPi + Vim a eu une résolution complète du tremblement contralatéral par la stimulation thalamique, mais moins de bénéfice de la stimulation GPi aiguë. Un patient a eu une crise épileptique unique une semaine après l'intervention. Aucune autre complication chirurgicale n'a été observée.

Conclusions:

La stimulation de régions profondes du cerveau peut être faite de façon sécuritaire et efficace chez les patients qui ont déjà eu une pallidotomie du côté opposé. L'effet de la stimulation de différents sites sur différents profils de symptômes et sur les dyskinésies induites par la lévodopa demande une investigation plus poussée.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue 4 , November 1998 , pp. 300 - 305
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

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