Efficacy, stability and predictors of outcome of pallidotomy for Parkinson's disease. Six-month follow-up with additional 1-year observations

Kishore, Asha; Turnbull, I. M.; Snow, Barry; Fuente‐Fernández, Raúl de la; Schulzer, Michael; Mak, Edwin; Yardley, S; Calne, D. B.

doi:10.1093/brain/120.5.729

Cited by 133 publications

(117 citation statements)

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“…537 Some debate remains with respect to the need for microelectrode guidance, with some arguing it is essential to find the optimal site for the lesion, 538 whereas others argue that the extra needle passes required increase the risk of hemorrhage and that similar results can be obtained without it. 539 There is little information on the efficacy of bilateral pallidotomy, as the procedure is rarely performed because of risk of side effects mentioned earlier.…”

Section: The Observation That Thalamotomy Is So Effective In Amelioramentioning

confidence: 99%

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

773

658

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Parkinson disease (PD) is an age-related neurodegenerative disorder that affects as many as 1-2% of persons aged 60 years and older. With the aging of the population, the frequency of PD is expected to increase dramatically in the coming decades. Current therapy is largely based on a dopamine replacement strategy, primarily using the dopamine precursor levodopa. However, chronic treatment is associated with the development of motor complications, and the disease is inexorably progressive. Further, advancing disease is associated with the emergence of features such as freezing, falling, and dementia which are not adequately controlled with dopaminergic therapies. Indeed, it is now appreciated that these nondopaminergic features are common and the major source of disability for patients with advanced disease. Many different therapeutic agents and treatment strategies have been evaluated over the past several years to try and address these unmet medical needs, and many promising approaches are currently being tested in the laboratory and in the clinic. As a result, there are now many new therapies and strategic approaches available for the treatment of the different stages of PD, with which the treating physician must be familiar in order to provide patients with optimal care. This monograph provides an overview of the management of PD patients, with an emphasis on pathophysiology, and the results of recent clinical trials. It is intended to provide physicians with an understanding of the different treatment options that are available for managing the different stages of the disease and the scientific rationale of the different approaches. 1 PD is the second most common neurodegenerative disorder, with an average age at onset of about 60 years. An estimated 5 million people throughout the world have PD, with 1 million individuals each in the United States and in Europe with the disorder. PD affects approximately 0.3% of the population and 1% to 2% of those older than 60 years.2 With the aging of the population and the substantial increase in the number of at-risk individuals older than 60 years, it is anticipated that the prevalence of PD will increase dramatically in the coming decades.

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Section: The Observation That Thalamotomy Is So Effective In Amelioramentioning

confidence: 99%

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

773

658

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“…55 Subthalamic nucleus lesions allow for a reduction in levodopa, whereas levodopa remains practically unchanged after pallidotomy. 88 This advantage is valuable when patients have levodopa-induced hallucinations. Although there are no studies on this matter, STN DBS was recently shown to reduce hallucinations after medication adjustments 172 and could be achieved with STN lesions.…”

Section: Subthalamotomy Versus Other Surgical Treatmentsmentioning

confidence: 99%

Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

Jourdain

Schechtmann

Paolo

2014

JNS

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Parkinson's disease (PD) is a neurodegenerative condition that can be pharmacologically treated with levodopa. However, important motor and nonmotor symptoms appear with its long-term use. The subthalamic nucleus (STN) is known to be involved in the pathophysiology of PD and to contribute to levodopa-induced complications. Surgery is considered in patients who have advanced PD that is refractory to pharmacotherapy and who display disabling dyskinesia. Deep brain stimulation of the STN is currently the main surgical procedure for PD, but lesioning is still performed. This review covers the clinical aspects and complications of subthalamotomy as one of the lesion-based options for PD patients with levodopa-induced dyskinesias. Moreover, the authors discuss the possible effects of subthalamic lesioning.

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“…The growing experience with pallidal lesions for Parkinson's disease shows frequent improvement of all kind of dyskinesias/dystonias, including the ones not related to L-Dopa therapy [3][4][5][6][7][8][9][10][11] . These findings, along with some recent reports of marked improvement in medically refractory dystonias prompted us to evaluate the effectiveness of this procedure in a group of selected patients [12][13][14][15][16] .…”

mentioning

confidence: 99%

Bilateral pallidotomy for generalized dystonia

Teive

Sá

Grande

et al. 2001

Arq. Neuro-Psiquiatr.

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-Objective: To evaluate the efficacy and safety of bilateral pallidotomies in five patients with generalized dystonia. Background: Generalized dystonias are frequently a therapeutic challenge, with poor responses to pharmacological treatment. GPi (globus pallidus internus) pallidotomies for Parkinson's disease ameliorate all kinds of dyskinesias/dystonia, and recent studies reported a marked improvement of refractory dystonias with this procedure. Methods: Five patients with generalized dystonias refractory to medical treatment were selected; one posttraumatic and four idiopathic. The decision to perform bilateral procedures was based on the predominant axial involvement in these patients. Dystonia severity was assessed with the Burke-FahnMarsden Dystonia Scale (BFM). Simultaneous procedures were performed in all but one patient, who had a staged procedure. They were reevaluated with the same scale (BFM) by an unblinded rater at 1, 2, 3, 30, 60, 90, 120 and 180 days post-operatively. Results: The four patients with idiopathic dystonia showed a progressive improvement up to three months; the patient with posttraumatic dystonia relapsed at three months. One patient had a marked improvement, being able to discontinue all the medications. A mean decrease in the BFM scores of 52,58% was noted. One patient had a trans-operative motor seizure followed by a transient hemiparesis secondary to rack hemorrhage; other was lethargic up to three days after the procedure. Conclusions: Our results show that bilateral GPi pallidotomies may be a safe and effective approach to medically refractory generalized dystonias; it can also be speculated that the posttraumatic subgroup may not benefit with this procedure.KEY WORDS: dystonia, pallidotomy, stereotactic surgery. Palidotomia bilateral para distonias generalizadasRESUMO -As distonias generalizadas são freqüentemente um desafio terapêutico, com pobres respostas aos tratamentos farmacológicos. As cirurgias estereotáxicas, como a palidotomia, têm sido utilizadas com êxito no tratamento da doença de Parkinson e estudos recentes relatam importante melhora das distonias generalizadas, refratárias ao tratamento farmacológico, com a palidotomia bilateral. O objetivo dos autores foi avaliar a eficácia e segurança da palidotomia bilateral em cinco pacientes com distonia generalizada. Foram selecionados cinco pacientes com distonia generalizada, predominante axial, refratários ao tratamento farmacológico (quatro idiopáticas e uma pós-traumática). A severidade da distonia foi avaliada através da escala de Burke-Fahn-Marsden (BFM), no 1º, 2º, e 3º dia após a cirurgia e nos dias 30, 60, 90, 120 e 180 do pós-operatório. Quatro pacientes com distonia idiopática tiveram uma progressiva melhora dentro de 3 meses após a cirurgia e o paciente com distonia pós-traumática teve uma piora da distonia após 3 meses da cirurgia. Um dos pacientes teve uma melhora acentuada do quadro de distonia, ficando livre das medicações. Em média ocorreu redução de 52,58 % dos escores da escala de BFM. Um dos...

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Efficacy, stability and predictors of outcome of pallidotomy for Parkinson's disease. Six-month follow-up with additional 1-year observations

Cited by 133 publications

References 3 publications

The scientific and clinical basis for the treatment of Parkinson disease (2009)

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

Bilateral pallidotomy for generalized dystonia

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