Microelectrode-guided pallidotomy: technical approach and its application in medically intractable Parkinson's disease

Vitek, Jerrold L.; Bakay, Roy A.E.; Hashimoto, Takao; Kaneoke, Yoshiki; Mewes, Klaus; Zhang, Jian Yu; Rye, David B.; Starr, Philip A.; Baron, Mark S.; Turner, Robert S.; DeLong, Mahlon R.

doi:10.3171/jns.1998.88.6.1027

Cited by 322 publications

(278 citation statements)

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“…For example, activation of the corticospinal tract within the internal capsule causes contralateral muscle contractions. 157,158 A recent computer modeling study described promising results in the prediction of current spread during DBS. 159 In these experiments, the locations of electrode contacts were reconstructed from postoperative MRI data, and a three-dimensional brain atlas was warped to the patient's MRI to identify anatomical structures and their position with respect to the stimulated electrode or electrodes.…”

Section: What To Avoid: Targets That Lead To Undesirable Side Effectsmentioning

confidence: 99%

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

et al. 2008

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Summary:Chronic electrical stimulation of the brain, known as deep brain stimulation (DBS), has become a preferred surgical treatment for medication-refractory movement disorders. Despite its remarkable clinical success, the therapeutic mechanisms of DBS are still not completely understood, limiting opportunities to improve treatment efficacy and simplify selection of stimulation parameters. This review addresses three questions essential to understanding the mechanisms of DBS. 1) How does DBS affect neuronal tissue in the vicinity of the active electrode or electrodes? 2) How do these changes translate into therapeutic benefit on motor symptoms? 3) How do these effects depend on the particular site of stimulation? Early hypotheses proposed that stimulation inhibited neuronal activity at the site of stimulation, mimicking the outcome of ablative surgeries. Recent studies have challenged that view, suggesting that although somatic activity near the DBS electrode may exhibit substantial inhibition or complex modulation patterns, the output from the stimulated nucleus follows the DBS pulse train by direct axonal excitation. The intrinsic activity is thus replaced by high-frequency activity that is time-locked to the stimulus and more regular in pattern. These changes in firing pattern are thought to prevent transmission of pathologic bursting and oscillatory activity, resulting in the reduction of disease symptoms through compensatory processing of sensorimotor information. Although promising, this theory does not entirely explain why DBS improves motor symptoms at different latencies. Understanding these processes on a physiological level will be critically important if we are to reach the full potential of this powerful tool.

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Section: What To Avoid: Targets That Lead To Undesirable Side Effectsmentioning

confidence: 99%

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

et al. 2008

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“…MRI images were subsequently reformatted and coordinates refined using a Stealth system. Intraoperatively, microelectrode penetrations were made through a burr hole to verify the neurophysiological target [29], [32]. Responses to sensory stimuli (passive movements of upper and lower limbs) were sought to identify the sensorimotor portion of the STN, where the DBS lead was subsequently placed ventral to this region.…”

Section: A Subjectsmentioning

confidence: 99%

Effects of STN DBS on Rigidity in Parkinson's Disease

Shapiro

Vaillancourt

Sturman

et al. 2007

IEEE Trans. Neural Syst. Rehabil. Eng.

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We quantified the effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and medication on Parkinsonian rigidity using an objective measure of work about the elbow joint during a complete cycle of imposed 1-Hz sinusoidal oscillations. Resting and activated rigidity were analyzed in four experimental conditions: 1) off treatment; 2) on DBS; 3) on medication; and 4) on DBS plus medication. Rigidity at the elbow joint was also assessed using the Unified Parkinson's Disease Rating Scale (UPDRS). We tested ten patients who received STN DBS and ten age-matched neurologically healthy control subjects. The activated rigidity condition increased work in both Parkinson's disease (PD) patients and control subjects. In PD patients, STN DBS reduced both resting and activated rigidity as indicated by work and the UPDRS rigidity score. This is the first demonstration that STN stimulation reduces rigidity using an objective measure such as work. In contrast, the presurgery dose of antiparkinsonian medication did not significantly improve the UPDRS rigidity score and reduced work only in the activated rigidity condition. Our results suggest that STN DBS may be more effective in alleviating rigidity in the upper limb of PD patients than medications administered at presurgery dosage level.

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“…Vários estudos são a favor da cirurgia ablativa na DP; porém, a sua indicação deve ser feita àqueles pacientes com comprometimento para realização das atividades diárias e que estejam, de alguma forma, dependentes [7][8][9][10][11][12][13] . A escolha do alvo cirúrgico neste estudo segue a tendência atual da literatura, que indica a PPV nos casos nos quais a bradicinesia, flutuações decorrentes do uso da levodopa e ocorrência de discinesias são predominantes [2][3][4]12,[14][15][16][17][18][19] .…”

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Avaliação das atividades da vida diária dos pacientes com doença de Parkinson submetidos a cirurgia estereotáxica

Pinto

Borges

Aguiar

et al. 2002

Arq. Neuro-Psiquiatr.

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RESUMO -Objetivo: Avaliar o impacto da cirurgia estereotáxica sobre a realização das atividades da vida diária dos paciente com doença de Parkinson (DP). Método: Foram avaliados 30 pacientes com DP forma idiopática submetidos a cirurgia estereotáxica nos períodos pré-operatório, 1º, 3º, 6º e 12º mês pós-operatório, segundo as escala UPDRS -Item II (escala unificada para DP), Schwab & England e Hoehn & Yahr. Destes, nove pacientes foram também avaliados no 24º mês pós-operatório. Resultados: Foram realizadas nove palidotomias póstero-ventrais (PPV), sendo duas à esquerda e sete à direita; duas PPV bilaterais no mesmo tempo cirúrgico; 17 talamotomias ventro-laterais (TVL), sendo 12 à esquerda e cinco à direita; duas TVL à esquerda com PPV à direita no mesmo tempo cirúrgico. Os escores médios, na fase off, das escalas utilizadas foram: 65,6 no pré-operatório,74 no 1º mês, 76,6 no 3º mês, 75,6 no 6º mês e 72,3 no 12º mês pós-operatório (Schwab & England); 21 no pré-operatório, 12,3 no 1º mês, 14,7 no 3º mês, 15,27 no 6º mês e 17,1 no 12º mês pós-operatório (UPDRS); 3,1 no pré-operatório, 2,8 no 1º mês, 2,7 no 3º mês, 2,8 no 6º mês e 2,85 no 12º mês pós-operatório (Hoehn & Yarh). Conclusão: A TVL e a PPV são procedimentos capazes de melhorar a independência dos pacientes para realização das atividades cotidianas, sendo constatado benefício maior nos seis primeiros meses de pós-operatório. PALAVRAS-CHAVE: doença de Parkinson, cirurgia estereotáxica, atividades da vida diária.Daily living activities in P Daily living activities in P Daily living activities in P Daily living activities in P Daily living activities in Parkinson's disease patients underwent to stereotactic surgery arkinson's disease patients underwent to stereotactic surgery arkinson's disease patients underwent to stereotactic surgery arkinson's disease patients underwent to stereotactic surgery arkinson's disease patients underwent to stereotactic surgery ABSTRACT -Objective: To evaluate the impact of stereotactic surgery on daily activities of Parkinson's disease (PD) patients. Method: Thirty patients with idiopathic PD were evaluated before surgery and one, three, six and twelve months after surgery. Patients were evaluated with the UPDRS -part II (Unified Parkinson's Disease Rating Scale) and the Schwab & England scales. Nine of the patients had also been evaluated after twenty four months. Results: We performed nine posteroventral pallidotomies (PVP), two on the left hemisphere and seven on the right; 17 ventrolateral thalamotomies (VLT), 12 on the left and five on the right; two VLT on the left associated with PVP on the right at the same surgical procedure. The mean "off" phase scores of Schwab & England scale were: 60.6 before surgery, 74 after the first, 76.6 after the third, 75.6 after the sixth, 72.3 after the twelfth and 71.1 after the twenty fourth months after surgery. The mean "off" phase scores of UPDRS -part II scale were: 21 before surgery, 12.3 after the first, 14.7 after the third, 15.27 after the sixth, 17.1 after the twelfth and 17....

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Microelectrode-guided pallidotomy: technical approach and its application in medically intractable Parkinson's disease

Abstract: These data provide important information concerning target identification for ablative or deep brain stimulation procedures in idiopathic Parkinson's disease and other movement disorders.

Cited by 322 publications

References 19 publications

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

Effects of STN DBS on Rigidity in Parkinson's Disease

Avaliação das atividades da vida diária dos pacientes com doença de Parkinson submetidos a cirurgia estereotáxica

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