Bilateral akinesia in drug‐induced parkinsonism after a subthalamic lesion

This study focuses on upper extremity strength and movement control in a patient with Parkinson's disease who had stimulating electrodes surgically implanted in the ventral intermediate nucleus (VIM) of the left thalamus. We examined torque generation and control of movement distance in single degree-of-freedom elbow movements under three different stimulation conditions: (a) no stimulation, (b) high stimulation, in which tremor was minimized but there was also tingling and perceived weakness, and (c) moderate stimulation, in which tremor was partially reduced, but there was also a subjective sense of increased strength compared with the high-stimulation condition. The patient's ability to generate both steady torque and rapid movements was poorest with no stimulation. The patient generated the largest torques with moderate stimulation and performed the fastest movements with high stimulation. However, even with tremor minimized, the patient's electromyogram (EMG) burst patterns were not typical of those of neurologically healthy subjects, although the movements were clearly improved.

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Effect of stimulation in the ventral intermediate nucleus of the thalamus on limb control in parkinson7apos;s disease: A case study

Pfann

Penn

Shannon

et al. 1996

Movement Disorders

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Tetrabenazine, a monoamine-depleting drug used in the treatment of hyperkinetic movement disorders

Guay

2010

The American Journal of Geriatric Pharmacotherapy

124

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Subthalamotomy in parkinsonian monkeys Behavioural and biochemical analysis

Guridi

Herrero

Luquin

et al. 1996

Brain

210

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Nineteen Macaca fascicularis monkeys were divided into four different groups: Group A (n = 3), control; Group B (n = 3), monkeys treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP); Group C (n = 8), animals treated with MPTP in which the subthalamic nucleus (STN) was unilaterally lesioned by kainic acid injection; in Group D (n = 5), the STN was lesioned prior to MPTP administration. Subthalamotomy resulted in a bilateral improvement of tremor, spontaneous activity, bradykinesia (evaluated by a manual motor test) and freezing in Group C. All these monkeys developed hemichorea contralateral to the lesion. The improvement was maintained and the hemichorea continued until death. The monkeys in group D showed severe hemiballism which persisted throughout MPTP administration and developed parkinsonian signs mainly on the side ipsilateral to the lesion. Analysis of the in situ hybridization of the mRNA coding for glutamic acid decarboxylase (GAD) of MPTP monkeys showed a significant increase in the mean density of silver grains over every labelled neuron in the globus pallidum lateralis (56.8% over control) as well as the globus pallidus medialis (GPM) (45.7% over control) and the substantia nigra reticulata (SNR) (35.8% over control). No significant change was observed in the thalamic nucleus reticularis. Subthalamotomy (Groups C and D) produced a significant reduction in mRNA GAD expression on the side of the lesion in the GPM and the SNR (34% and 42.3%, respectively) with respect to the ipsilateral (non-lesioned) side and also when compared with parkinsonian monkeys. These results confirm and expand, at the cellular level, the paramount role of STN hyperactivity in the pathophysiology of parkinsonism. The therapeutic consequences of these findings for surgical treatment of Parkinson's disease are discussed.

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Bilateral akinesia in drug‐induced parkinsonism after a subthalamic lesion

Cited by 3 publications

References 7 publications

Effect of stimulation in the ventral intermediate nucleus of the thalamus on limb control in parkinson7apos;s disease: A case study

Effect of stimulation in the ventral intermediate nucleus of the thalamus on limb control in parkinson7apos;s disease: A case study

Tetrabenazine, a monoamine-depleting drug used in the treatment of hyperkinetic movement disorders

Subthalamotomy in parkinsonian monkeys Behavioural and biochemical analysis

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