Psychomotor and executive functioning after unilateral posteroventral pallidotomy in patients with Parkinson's disease

Olzak, Magdalena; Laskowska, Ilona; Jelonek, Jacek; Michalak, Maciej; Szołna, Adam; Gryz, Julita; Harat, Marek; Gorzelańczyk, Edward Jacek

doi:10.1016/j.jns.2006.05.046

Cited by 8 publications

(7 citation statements)

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“…DBS of the GPi was introduced, in part, to reduce the neurological complications of radiofrequency pallidotomy such as weakness, imbalance, cognitive abnormalities, and visual field defects . Beneficial effects of GPi DBS that are similar to that of pallidotomy are well documented using this strategy to ameliorate motor features of PD .…”

Section: Pallidotomymentioning

confidence: 99%

“…were part of a recently completed larger multicenter open‐label study of MRgFUS pallidotomy for PD (unpublished data). Because of previous reports of adverse effects on cognition with bilateral radiofrequency pallidotomy, this team elected to perform only unilateral lesions . In light of this design limitation, only patients who had either unilateral or highly asymmetric motor signs of PD were included in the study.…”

Section: Pallidotomymentioning

confidence: 99%

“…[56][57][58] DBS of the GPi was introduced, in part, to reduce the neurological complications of radiofrequency pallidotomy such as weakness, imbalance, cognitive abnormalities, and visual field defects. [59][60][61][62][63][64] Beneficial effects of GPi DBS that are similar to that of pallidotomy are well documented using this strategy to ameliorate motor features of PD. 25,[65][66][67] DBS is, however, still an open surgical procedure and shares with radiofrequency pallidotomy the risk of intracranial bleeding and infection.…”

Section: Pallidotomymentioning

confidence: 99%

“…Because of previous reports of adverse effects on cognition with bilateral radiofrequency pallidotomy, this team elected to perform only unilateral lesions. [61][62][63][64] In light of this design limitation, only patients who had either unilateral or highly asymmetric motor signs of PD were included in the study. Because previous literature supported a direct antidyskinesia effect of pallidotomy, these patients not only had functionally interfering dose fluctuations (with a score of at least 3 in response to question 4.2 of the MDS-UPDRS), but also had bothersome L-dopa-induced dyskinesias with baseline total UDysRS mean scores of 36.1.…”

Section: Pallidotomymentioning

confidence: 99%

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The role of high‐intensity focused ultrasound as a symptomatic treatment for Parkinson's disease

et al. 2019

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MR‐guided focused ultrasound is a novel, minimally invasive surgical procedure for symptomatic treatment of PD. With this technology, the ventral intermediate nucleus, STN, and internal globus pallidus have been targeted for therapeutic cerebral ablation, while also minimizing the risk of hemorrhage and infection from more invasive neurosurgical procedures. In a double‐blinded, prospective, sham‐controlled randomized controlled trial of MR‐guided focused ultrasound thalamotomy for treatment of tremor‐dominant PD, 62% of treated patients demonstrated improvement in tremor scores from baseline to 3 months postoperatively, as compared to 22% in the sham group. There has been only one open‐label trial of MR‐guided focused ultrasound subthalamotomy for patients with PD, demonstrating improvements of 71% for rigidity, 36% for akinesia, and 77% for tremor 6 months after treatment. Among the two open‐label trials of MR‐guided focused ultrasound pallidotomy for patients with PD, dyskinesia and overall motor scores improved up to 52% and 45% at 6 months postoperatively. Although MR‐guided focused ultrasound thalamotomy is now approved by the U.S. Food and Drug Administration for treatment of parkinsonian tremor, additional high‐quality randomized controlled trials are warranted and are underway to determine the safety and efficacy of MR‐guided focused ultrasound subthalamotomy and pallidotomy for treatment of the cardinal features of PD. These studies will be paramount to aid clinicians to determine the ideal ablative target for individual patients. Additional work will be required to assess the durability of MR‐guided focused ultrasound lesions, ideal timing of MR‐guided focused ultrasound ablation in the course of PD, and the safety of performing bilateral lesions. © 2019 International Parkinson and Movement Disorder Society

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Section: Pallidotomymentioning

confidence: 99%

Section: Pallidotomymentioning

confidence: 99%

Section: Pallidotomymentioning

confidence: 99%

Section: Pallidotomymentioning

confidence: 99%

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The role of high‐intensity focused ultrasound as a symptomatic treatment for Parkinson's disease

et al. 2019

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“…Many of the recent reports on pallidotomy have come from China, Taiwan, South Korea, Hungary, Poland, and Brazil. [75][76][77][78][79][80][81] Given the expense of hardware and hardware-related complications, and the labor intensiveness of programming and the great distance that may need to be traveled to programming centers, it is difficult to envision this situation changing soon.…”

Section: Is There Still a Role For Lesion Therapy For Pd?mentioning

confidence: 99%

What Happened to Posteroventral Pallidotomy for Parkinson’s Disease and Dystonia?

Gross

2008

Neurotherapeutics

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Summary: Fifteen years after its resurrection, pallidotomy for Parkinson's disease (PD) and dystonia has once again been supplanted, this time by deep brain stimulation (DBS). Did this occur because pallidotomy was not effective or safe, or because DBS was found to be more effective and safer? This review focuses on the evidence-and its quality-supporting the effectiveness and safety of pallidotomy for PD and dystonia, and the comparative effectiveness and safety of DBS of the subthalamic nucleus (STN) and globus pallidus pars interna (GPi). Discussed first are the determinants of "level 1" recommendations, including the confounding effects on interpretation of randomized clinical trials (RCTs) that fail to control for patient bias (i.e., placebo effects). Although several RCTs have been performed comparing unilateral pallidotomy to medical therapy, GPi DBS, or STN DBS for PD, none controlled for patient bias. Comparison of these trials to estimate the placebo effect, and examination of retrospective case series, suggests that the true effectiveness of unilateral pallidotomy is 20% to 30% reduction of 'off' total motor UPDRS scores, which is similar to the effects of unilateral GPi DBS or STN DBS, but less than bilateral STN DBS. At experienced centers, safety of unilateral pallidotomy appears equivalent to unilateral DBS, but bilateral DBS is likely safer than bilateral pallidotomy. Whereas there have been no RCTs of pallidotomy for dystonia, two doubleblind, sham-controlled RCTs of bilateral GPi DBS were performed. Nevertheless, limited uncontrolled series suggest that bilateral pallidotomy is similar to GPi DBS in effectiveness and safety for dystonia. Thus, pallidotomy was not rejected because of lack of effectiveness or safety, and it remains a viable alternative in situations where DBS is not available or not feasible.

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Advances in clinical basic research: Performance, treatments, and mechanisms of Parkinson disease

Yang

Liu

et al. 2021

Ibrain

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The loss of neuronal in the substantia nigra of the elderly contributes to striatal damage and plays a critical part in the common forms of neurodegenerative diseases such as Parkinson disease (PD). The deficit of dopamine is one of the most familiar neuropathological features of PD as well as α-Synuclein aggregation. The peripheral autonomic nervous system is al so affected negatively during the course of the disease, although the subsistent of dyskinesias and else major motor characteristic deficits take significant role in the diagnostic methods during clinical practice, which is related to a number of non-motor symptoms that might increase aggregate risks. Multiple pathways and mechanisms are involved in the molecular pathogenesis: α-Synuclein, neuronal homeostasis, mitochondrial function, oxidative stress, as well as neuroinflammation. Investigations in the last few years for diagnostic biomarkers used neuroimaging, including single photon emission computed tomography as well as cutting-edge magnetic resonance imaging techniques, which has been presented to facilitate discrepant diagnosis.Pharmacological treatment is also important and efficient in equal measure. In addition to reliance on striatal dopamine replacement therapy, many solutions that are used for motor or nonmotor symptoms in these patients are available.

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Psychomotor and executive functioning after unilateral posteroventral pallidotomy in patients with Parkinson's disease

Cited by 8 publications

References 50 publications

The role of high‐intensity focused ultrasound as a symptomatic treatment for Parkinson's disease

The role of high‐intensity focused ultrasound as a symptomatic treatment for Parkinson's disease

What Happened to Posteroventral Pallidotomy for Parkinson’s Disease and Dystonia?

Advances in clinical basic research: Performance, treatments, and mechanisms of Parkinson disease

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