Bilateral subthalamotomy in Parkinson's disease: initial and long-term response

Álvarez, L.; Macıás, R.; López, G.; Álvarez, E. Castañón; Pavón, Nancy; Rodriguez-Oroz, María C.; Juncos, Jorge L.; Maragoto, Carlos; Guridi, Jorge; Litvan, Irene; Tolosa, Eduardo; Koller, William C.; Vitek, Jerrold L.; DeLong, Mahlon R.; Obeso, José A.

doi:10.1093/brain/awh397

Cited by 199 publications

(160 citation statements)

References 85 publications

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“…In the 6-OHDA rat, unilateral lesion of the Pf is associated with significant amelioration of basal ganglia metabolic abnormalities 30 and unilateral surgery of the STN or GPi may portray a robust anti-parkinsonian action in both MPTP monkeys and patients with PD. 46,47 Finally, it may be argued that the sample size is too small to reach any valuable conclusion. We, indeed, acknowledge that a number of two monkeys with accurate placement of the lesions is definitely limited.…”

Section: Discussionmentioning

confidence: 99%

Lesion of the centromedian thalamic nucleus in MPTP‐treated monkeys

et al. 2008

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The caudal intralaminar nuclei are a major source of glutamatergic afferents to the basal ganglia. Experiments in the 6-hydroxydopamine rat model have shown that the parafascicular nucleus is overactive and its lesion alleviates basal ganglia neurochemical abnormalities associated with dopamine depletion. Accordingly, removal of this excitatory innervation of the basal ganglia could have a beneficial value in the parkinsonian state. To test this hypothesis, unilateral kainate-induced chemical ablation of the centromedian thalamic nucleus (CM) has been performed in MPTPtreated monkeys. Successful lesions restricted to the CM boundaries (n = 2) without spreading over other neighboring thalamic nuclei showed an initial, short-lasting, and mild change in the parkinsonian motor scale but no effect against levodopa-induced dyskinesias. The lack of significant and persistent motor improvement leads us to conclude that unilateral selective lesion of the CM alone cannot be considered as a suitable surgical approach for the treatment of PD or levo-dopa-induced dyskinesias. The role of the caudal intralaminar nuclei in the pathophysiology of movement disorders of basal ganglia origin remains to be clarified. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptThe centromedian-parafascicular thalamic complex (CM-Pf) is one major source of glutamatergic innervation of several basal ganglia nuclei, including the striatum, 1-15 the subthalamic nucleus (STN), 4,7,[12][13][14][15][16][17][18][19][20][21] the globus pallidus, and the substantia nigra. 15,21,22 Projections arising from the caudal intralaminar nuclei are excitatory and use glutamate as neurotransmitter. [23][24][25] In recent years, a number of studies have suggested a possible role for the CM-Pf complex on the pathophysiology of movement disorders. 26,27 In rats, Pf neurons that innervate the STN 28,29 and the striatum 25 are known to be hyperactive after unilateral midbrain dopaminergic lesion with 6-hydroxydopamine (6-OHDA). Indeed, the chemical ablation of Pf in rodents is highly effective in reversing the increases on STN metabolic activity typically observed after dopamine depletion. 30 Interestingly, early observations considered the CM/Pf as a target by deep brain stimulation (DBS) for the treatment of levodopainduced dyskinesias in Parkinson's disease, [31][32][33] and this has recently been proposed in combination with DBS of the globus pallidus pars interna (GPi). 34 On the other hand, important cell loss has been described in the CM-Pf of PD patients 35 as well as in rodents after nigrostriatal damage. 25,36 To further assess the relevance of the CM/Pf as a potential therapeutic target for parkinsonism and levodopa-induced dyskinesias, we have performed chemical ablation of the caudal intralaminar nuclei in MPTP-treated monkeys and determined its impact on parkinsonian motor signs and dyskinesias. SUBJECTS AND METHODSA total number of five young adult male Macaca fascicularis primates (body weight ranging fr...

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Section: Discussionmentioning

confidence: 99%

Lesion of the centromedian thalamic nucleus in MPTP‐treated monkeys

et al. 2008

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“…Biballism is a well-known and mostly transient side effect of bilateral subthalamotomy although in some patients additional pallidotomy was required because of long lasting, disabling dyskinesias [2]. STN chronic stimulation is costly and may require frequent adjustments.…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 99%

“…The present case report is valuable as it allows comparing the effect of each method in the same patient with a relatively long follow-up. The benefits of subthalamotomy have been reported to persist for a follow-up of 3e6 years [2]. Some loss of benefit over time however has been noted in a subpopulation [2] whereas the benefit was maintained up to 24 months in some patients [4] while long-term STN stimulation efficacy with stable effect on tremor and rigidity has been reported with a follow-up of 5e10 years [1].…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 99%

“…The benefits of subthalamotomy have been reported to persist for a follow-up of 3e6 years [2]. Some loss of benefit over time however has been noted in a subpopulation [2] whereas the benefit was maintained up to 24 months in some patients [4] while long-term STN stimulation efficacy with stable effect on tremor and rigidity has been reported with a follow-up of 5e10 years [1]. STN stimulation is a reversible and adaptable treatment and the stimulation of each STN can be separately adjusted over time, which is not possible with subthalamotomy.…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 99%

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Subthalamic stimulation or subthalamic lesion for Parkinson's disease ? A case report

Anheim

Dowsey-Limousin

Krack

et al. 2015

Parkinsonism & Related Disorders

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“…As a result, there continue to be many publications, mostly from outside North America and Europe, regarding thalamotomy, pallidotomy, and subthalamotomy. [81][82][83][84][85][86] Lesions (generally unilateral to decrease the risk) created with stereotactic radiosurgery are options for patients who are poor operative risks due to their general medical condition or coagulopathy. [87][88][89][90] Although there are clearly complications from stereotactic radiosurgery, as with any procedure, the overall complication rate is unclear, because many patients who suffer them go to other centers.…”

Section: Is There Still a Role For Lesional Surgery?mentioning

confidence: 99%

The History and Future of Deep Brain Stimulation

2008

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Summary:The advancement of electrical stimulation of the central nervous system has been a story of fits and bursts with numerous setbacks. In many ways, this history has paralleled the history of medicine and physics. We have moved from anecdotal observation to double-blinded, prospective randomized trials. We have moved from faradic stimulation to systems that lie completely under the skin and can deliver complex electrical currents to discrete areas of the brain while controlled through a device that is not much bigger than a PDA. This review will discuss how deep brain stimulation has developed into its current form, where we see the field going and the potential pitfalls along the way.

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Bilateral subthalamotomy in Parkinson's disease: initial and long-term response

Cited by 199 publications

References 85 publications

Lesion of the centromedian thalamic nucleus in MPTP‐treated monkeys

Lesion of the centromedian thalamic nucleus in MPTP‐treated monkeys

Subthalamic stimulation or subthalamic lesion for Parkinson's disease ? A case report

The History and Future of Deep Brain Stimulation

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