Bilateral Chronic Electrostimulation of Ventroposterolateral Pallidum

Abstract

The global improvement of all parkinsonian symptoms after stereotactic pallidotomy has been demonstrated by Leksell. Recently, Laitinen, re-evaluating this target in the neurosurgical treatment of Parkinson's disease, confirmed the real value of this approach, and emphasized the necessity of locating the lesion in the ventroposterolateral part of the pallidum internum. Because we know that high-frequency stimulation of the ventrolateral part of the thalamus has the same clinical effect on tremor as high-frequency coagulation, this technique has now been applied bilaterally in one session in three patients who have severe Parkinson's disease, with akinesia and levodopa-induced dyskinesias in the foreground. The very satisfactory clinical results, up to 12 months in the first case, confirm the observation of Laitinen, but with the difference that the approach discussed here is both nondestructive and reversible, and unwanted side effects are avoided.

Improvement of Advanced Parkinson’s Disease Manifestations with Deep Brain Stimulation of the Subthalamic Nucleus: A Single Institution Experience

“…The first attempt to use the GPi as the target of DBS to treat PD was by Siegfried and Lippitz, published in 1994. DBS of the GPI proved efficiency in controlling tremors, bradykinesia, and drug-induced dyskinesias [14,15,16]. The subthalamic nucleus (STN) was investigated in animal studies as a target for Parkinson’s disease surgery [17].…”

Evaluation of Thiel cadaveric model for MRI-guided stereotactic procedures in neurosurgery

“…The use of computer-assisted neurosurgery is an established technique in functional neurosurgical procedures such as treatment of Parkinson's disease,[12349182930] dystonia,[35] tremor[25] and craniotomy for intracranial lesions,[12] and gaining support in the treatment of epilepsy,[1331] chronic pain,[817] and psychiatric disorders. [2026] These procedures include ablative procedures such as thalamotomy,[4] pallidotomy,[1830] anterior cingulotomy, anterior capsulotomy, and lesionectomy,[12] or neurostimulation such as deep brain stimulation (DBS).…”

“…[2026] These procedures include ablative procedures such as thalamotomy,[4] pallidotomy,[1830] anterior cingulotomy, anterior capsulotomy, and lesionectomy,[12] or neurostimulation such as deep brain stimulation (DBS). [1234589131718202629303135] The main techniques used to generate stereotactic ablative procedures are stereotactic radiofrequency thermal lesioning or stereotactic radiosurgery (SRS). High frequency focused ultrasound (HFFUS), in contrast, is a newer less-invasive technique using ultrasonic energy to thermally ablate a target in the brain.…”

Deep brain stimulation for movement and other neurologic disorders

“…These encouraging results lead to clinical trials of STN DBS in patients with PD, which was shown to be safe and highly effective [13–15]. Similarly positive results were also described for DBS of the GPi [16]. Because DBS has the advantage of being less invasive than lesioning, and DBS effects are adjustable, it did not take long for DBS to replace pallidotomy and other ablative procedures as the neurosurgical treatment of choice for PD patients (at least in developed countries).…”