Results of Spinal Pyramidotomy in the Treatment of the Parkinsonian Syndrome

Putnam, Tracy J.; Herz, Ernst

doi:10.1001/archneurpsyc.1950.02310210003001

Cited by 19 publications

(5 citation statements)

References 7 publications

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“…Unfortunately the question is not at all academic because, lacking better information, surgeons have chiefly attempted to control hyperkinetic disorders by the only scheme in sight (namely, resection of portions of the pyramidal system (1, 2)), thus substituting paralysis for tremor. In some of the patients undergoing cortical extirpation seizures developed postoperatively; Putnam (3) mentions, in addition, aphasia. Putnam's method of sectioning pyramidal fibers in the cervical cord was said to permit a later return of motor power, but Browder (19) has reported that tremor also returns.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical intervention in parkinsonism has not been generally considered to offer much hope for solution of the problem (1). Hitherto it has mainly consisted of damaging the corticospinal (pyramidal) system, either at the motor cortex (1, 2) or in the cervical cord (3), and so producing a loss of motor power and some relief of tremor. As late as 1954, Merritt (4) asserted that surgical procedures “appear to have some degree of success only when the corticospinal tracts are injured and a hemiplegia or mild hemiparesis is substituted for the tremor or rigidity.”…”

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confidence: 99%

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Surgical Alleviation of Parkinsonism: Effects of Occlusion of the Anterior Choroidal Artery*

Cooper

1954

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Surgical Alleviation of Parkinsonism: Effects of Occlusion of the Anterior Choroidal Artery*

Cooper

1954

J American Geriatrics Society

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“…Other investigators attempted pedunculotomy, spinal cord sectioning, and lesioning of the internal capsule, all with high morbidity and inconsistent results (Table 1). 18–21 Gradually, the field moved away from the notion that sectioning motor fibers was beneficial in the treatment of tremor and hypokinetic or hyperkinetic movement disorders. The important lesson had been learned that by sectioning the pyramidal tract at any level, improvements in tremor did not extend beyond that expected from paralysis.…”

Section: History Of Stereotaxic Surgery: the Rise Fall Rise And Famentioning

confidence: 99%

Lesion therapy for Parkinson's disease and other movement disorders: Update and controversies

2004

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An analysis of the international literature on lesioning for movement disorders was undertaken to review lesion therapy for Parkinson's disease (PD) and other movement disorders and to highlight important controversies surrounding this surgical technique. Lesions have been placed throughout the neuraxis with varying approaches and success. Our understanding of the pathophysiological basis underlying the development of PD and other movement disorders has led to a better understanding of why lesioning certain portions of the nervous system should improve motor function. Advances in imaging technology and electrophysiological techniques used for localization of brain structures, such as microelectrode mapping, have improved the ability to accurately identify and lesion target structures deep in the brain. This improvement has led to an increase in the degree and consistency of clinical benefit. The major controversies in lesion therapy include: (1) which target for which disorder; (2) determination of the optimal lesion site and whether the external globus pallidus (GPe) should be included in the pallidotomy lesion for PD; (3) determination of the size of the lesion; (4) whether bilateral lesions can be placed without the high incidence of side effects reported by some investigators; (5) whether microelectrodes aid in the ability to improve clinical outcomes or increase the risk of side effects by making multiple microelectrode penetrations; (6) whether the subthalamic nucleus (STN) should be explored further as a lesioning target; and (7) whether lesioning should be abandoned entirely in favor of deep brain stimulation (DBS). Many important questions and controversies regarding lesion therapy remain unanswered. It is unlikely given the pro-DBS environment that these questions will be answered in the near future. We should, however, be careful not to abandon an effective therapy before fully exploring through randomized trials the relative effect of different surgical approaches for the treatment of patients with movement disorders.

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“…Bucy and Case (2) and Klemme (3) lesioned the cortex and Browder (4) the internal capsule, while others such as Meyers (5), Spiegel et al (6) and Spiegel and Wycis (7), Fenelon (8), Guiot and Brion (9), and Cooper (10) made lesions in regions of the thalamus and basal ganglia. Still others destroyed portions of the peduncle (11) or spinal cord (12) or ablated the posterior nerve roots (13). Many patients died while others suffered serious morbidity; however, a few improved.…”

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confidence: 99%

Understanding Parkinson’s disease and deep brain stimulation: Role of monkey models

Vitek

Johnson

2019

Proc. Natl. Acad. Sci. U.S.A.

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Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder affecting over 10 million people worldwide. In the 1930s and 1940s there was little understanding regarding what caused PD or how to treat it. In a desperate attempt to improve patients’ lives different regions of the neuraxis were ablated. Morbidity and mortality were common, but some patients’ motor signs improved with lesions involving the basal ganglia or thalamus. With the discovery ofl-dopa the advent of medical therapy began and surgical approaches became less frequent. It soon became apparent, however, that medical therapy was associated with side effects in the form of drug-induced dyskinesia and motor fluctuations and surgical therapies reemerged. Fortunately, during this time studies in monkeys had begun to lay the groundwork to understand the functional organization of the basal ganglia, and with the discovery of the neurotoxin MPTP a monkey model of PD had been developed. Using this model scientists were characterizing the physiological changes that occurred in the basal ganglia in PD and models of basal ganglia function and dysfunction were proposed. This work provided the rationale for the return of pallidotomy, and subsequently deep brain stimulation procedures. In this paper we describe the evolution of these monkey studies, how they provided a greater understanding of the pathophysiology underlying the development of PD and provided the rationale for surgical procedures, the search to understand mechanisms of DBS, and how these studies have been instrumental in understanding PD and advancing the development of surgical therapies for its treatment.

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Results of Spinal Pyramidotomy in the Treatment of the Parkinsonian Syndrome

Cited by 19 publications

References 7 publications

Surgical Alleviation of Parkinsonism: Effects of Occlusion of the Anterior Choroidal Artery*

Surgical Alleviation of Parkinsonism: Effects of Occlusion of the Anterior Choroidal Artery*

Lesion therapy for Parkinson's disease and other movement disorders: Update and controversies

Understanding Parkinson’s disease and deep brain stimulation: Role of monkey models

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