Five-year follow-up of unilateral posteroventral pallidotomy in Parkinson's disease

Strutt, Adriana M.; Lai, Eugene C.; Jankovic, Joseph; Atassi, Farah; Soety, Elizabeth; Levin, Harvey S.; Grossman, Robert G.; York, Michele K.

doi:10.1016/j.surneu.2008.03.039

Cited by 25 publications

(19 citation statements)

References 45 publications

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“…At 5 years after unilateral pallidotomy, motor UPDRS improved by 19% to 27%,41, 42 overall disability in the On‐medication condition (S & E scores) was stable,41 and ADL in the Off‐medication state improved 42. Mean tremor reduction was 65% after 4 to 5 years,41 and, if initially controlled by surgery, contralateral tremor remained improved up to 10 years 40.…”

Section: Long‐term Evolution Of Pd In Patients Treated With Lesionsmentioning

confidence: 96%

“…Cognitive decline was reported after 542 and 10 years of disease evolution,40 whereas LEDD increased in all patients who were followed for up to 10 years, without recurrence or induction of dyskinesia contralateral to pallidotomy 40. Severity of dyskinesia contralateral to pallidotomy diminished by 70% to 75% (UPDRS‐IV subscores)41, 42 after 5 years. Moreover, in a small subgroup of patients followed for up to 12 years, there was a tendency toward a sustained improvement in dyskinesia, although other parkinsonian signs did not improve 43…”

Section: Long‐term Evolution Of Pd In Patients Treated With Lesionsmentioning

confidence: 97%

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Long‐term outcomes of surgical therapies for Parkinson's disease

2012

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The surgical lesion of different brain structures has been used as a treatment for Parkinson's disease (PD) for several decades. More recently, the favored therapeutic approach has involved the administration of levodopa and the use of DBS. These two major therapeutic advances have greatly modified both the clinical condition of patients and the history of the disease. With the introduction of L‐dopa in 1967, patients could regain mobility, because their akinesia, tremor, and rigidity were greatly improved, with consequent significant improvement in quality of life and increased life expectancy. However, after the so‐called “honeymoon” period in which the disease seemed to be controlled, motor fluctuations and L‐dopa‐induced dyskinesias mitigated the initial enthusiasm. In the 1990s, unilateral pallidotomy and DBS of the globus palllidus internus and STN reduced these motor fluctuations and dyskinesias remarkably, thereby inaugurating a new era in the surgical treatment of PD. Short‐ and medium‐term follow‐up studies of patients who underwent surgery have documented sustained, significant motor benefits. However, given the progressive nature of PD and the purely symptomatic effects of pallidotomy and DBS, the long‐term clinical evolution of these surgical patients currently seems to be associated with a new PD phenotype, mainly characterized by axial motor problems and cognitive impairment. Here, we analyze the long‐term clinical outcomes of surgical PD patients with at least 5‐year follow‐up, focusing on the long‐term motor symptoms that were initially responsive to surgery. © 2012 Movement Disorder Society

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Section: Long‐term Evolution Of Pd In Patients Treated With Lesionsmentioning

confidence: 96%

Section: Long‐term Evolution Of Pd In Patients Treated With Lesionsmentioning

confidence: 97%

Long‐term outcomes of surgical therapies for Parkinson's disease

2012

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“…Both segments of the globus pallidus, internal and external (Crossman, 1990;Obeso et al, 2008;Strutt et al, 2009) are overactive in animal models of L-DOPA-induced dyskinesia, and likewise in dyskinetic PD patients. The rodent equivalent of the primate external globus pallidus is the lateral pallidum (Maurice et al, 1997).…”

Section: Regional Distribution Of the Glial-inflammatory Markersmentioning

confidence: 99%

Glial activation is associated with l-DOPA induced dyskinesia and blocked by a nitric oxide synthase inhibitor in a rat model of Parkinson's disease

Bortolanza

Cavalcanti-Kiwiatkoski²,

Padovan-Neto³

et al. 2015

Neurobiology of Disease

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“…Pallidotomy has a prolonged effect on contralateral dyskinesia with previous studies having reported benefit lasting up to 13.5 years even when akinesia and other PD symptoms had returned 5. Other studies have also reported sustained benefit from unilateral pallidotomy on contralateral dyskinesia 1, 8, 9. None of these studies evaluated LID in a blinded fashion.…”

Section: Discussionmentioning

confidence: 98%

Long‐term effect of unilateral pallidotomy on levodopa‐induced dyskinesia

et al. 2010

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Unilateral pallidotomy has been effectively used to treat parkinsonism and reduce levodopa induced dyskinesia (LID). We sought to determine the long-term effects of pallidotomy on LID in 10 patients who had initial benefit from pallidotomy but went on to require DBS surgery for symptom progression. The Dyskinesia Rating Scale (DRS) was used to rate and quantify LID in a blinded fashion. Though sample size was small, there was a trend towards a reduction in LID lasting up to 12 years suggesting that posteroventral pallidotomy may provide sustained benefit in reducing LID.

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Five-year follow-up of unilateral posteroventral pallidotomy in Parkinson's disease

Cited by 25 publications

References 45 publications

Long‐term outcomes of surgical therapies for Parkinson's disease

Long‐term outcomes of surgical therapies for Parkinson's disease

Glial activation is associated with l-DOPA induced dyskinesia and blocked by a nitric oxide synthase inhibitor in a rat model of Parkinson's disease

Long‐term effect of unilateral pallidotomy on levodopa‐induced dyskinesia

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