Mechanical Injury of the Subthalamic Area During Stereotactic Surgery Followed by Improvement of Trunk, Neck, and Face Tremor-Case Report-

Hirashima, Yutaka; Ikeda, Hiroaki; Asahi, Takashi; Shibata, Takashi; Noguchi, Kyo; Shima, Fumio; Endo, Shunro

doi:10.2176/nmc.45.484

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…Collateral brain oedema in implanted patients has already been observed around deep [3], [34], [60] as well as strip electrodes with a relatively low incidence of 1–2% [61], [62]. The frequent detection of oedema in our study may have to do with our specific aim to search for even its minimal signs early after surgery.…”

Section: Discussionmentioning

confidence: 68%

“…Unlike previous studies, we explored the microlesion phenomenon while using an active motor task involving finger tapping well known from the Unified Parkinson's Disease Rating Scale (UPDRS-III). We hypothesized that apart from neuronal loss caused by electrode insertion, clinical consequences would also arise from a collateral oedema developing around the electrode [3], [33], [34]. Therefore, we introduced simple scales for quantifying the extent of cortical and subcortical oedema to compare it with the postoperative changes in the UPDRS-III and fMRI.…”

Section: Introductionmentioning

confidence: 99%

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The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

et al. 2012

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Electrode implantation into the subthalamic nucleus for deep brain stimulation in Parkinson's disease (PD) is associated with a temporary motor improvement occurring prior to neurostimulation. We studied this phenomenon by functional magnetic resonance imaging (fMRI) when considering the Unified Parkinson's Disease Rating Scale (UPDRS-III) and collateral oedema. Twelve patients with PD (age 55.9± (SD)6.8 years, PD duration 9–15 years) underwent bilateral electrode implantation into the subthalamic nucleus. The fMRI was carried out after an overnight withdrawal of levodopa (OFF condition): (i) before and (ii) within three days after surgery in absence of neurostimulation. The motor task involved visually triggered finger tapping. The OFF/UPDRS-III score dropped from 33.8±8.7 before to 23.3±4.8 after the surgery (p<0.001), correlating with the postoperative oedema score (p<0.05). During the motor task, bilateral activation of the thalamus and basal ganglia, motor cortex and insula were preoperatively higher than after surgery (p<0.001). The results became more enhanced after compensation for the oedema and UPDRS-III scores. In addition, the rigidity and axial symptoms score correlated inversely with activation of the putamen and globus pallidus (p<0.0001). One month later, the OFF/UPDRS-III score had returned to the preoperative level (35.8±7.0, p = 0.4).In conclusion, motor improvement induced by insertion of an inactive electrode into the subthalamic nucleus caused an acute microlesion which was at least partially related to the collateral oedema and associated with extensive impact on the motor network. This was postoperatively manifested as lowered movement-related activation at the cortical and subcortical levels and differed from the known effects of neurostimulation or levodopa. The motor system finally adapted to the microlesion within one month as suggested by loss of motor improvement and good efficacy of deep brain stimulation.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

et al. 2012

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“…38,45,72,87,122 A recollection of studies indicates that subthalamotomies have beneficial effects on the motor symptoms in both off-and on-medication states with better results from bilateral lesions. The surgery significantly reduces contralateral cardinal symptoms (tremor, bradykinesia, and rigidity).…”

Section: Parkinsonian Symptomsmentioning

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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“…Indeed, some have shown that high frequency DBS has an inhibitory effect on STN (Toleikis et al, 2007). Alternatively, introducing the DBS lead into the STN may truly lesion this area (Hirashima et al, 2005), though this observation is debated in post-mortem literature (Haberler et al, 2000;Henderson et al, 2001).…”

Section: Dbs and The Basal Ganglia Circuitry In Parkinson's Diseasementioning

confidence: 99%

Cognition following bilateral deep brain stimulation surgery of the subthalamic nucleus for Parkinson's disease

Halpern

Rick

Danish

et al. 2008

Int J Geriat Psychiatry

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Mechanical Injury of the Subthalamic Area During Stereotactic Surgery Followed by Improvement of Trunk, Neck, and Face Tremor-Case Report-

Cited by 4 publications

References 7 publications

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

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

Cognition following bilateral deep brain stimulation surgery of the subthalamic nucleus for Parkinson's disease

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