Acute and chronic effects of anteromedial globus pallidus stimulation in Parkinson's disease

Durif, Franck; Lemaire, Jean‐Jacques; Debilly, Bérengère; Dordain, G

doi:10.1136/jnnp.67.3.315

Cited by 40 publications

(37 citation statements)

References 39 publications

(11 reference statements)

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“…Indirect support for a similar functional subdivision within human GPi could come from studies on the behavioral effects of the location of DBS electrodes or pallidotomy lesions (Durrif et al 1999;Gross et al 1999). In a recent study of parkinsonian patients who had undergone pallidotomy, Lombardi et al (2000) could indeed demonstrate a correlation between cognitive outcome and lesion location along the anteromedial-toposterolateral axis in GPi.…”

Section: Neuroanatomical Interpretationmentioning

confidence: 98%

Effects of pallidal deep brain stimulation and levodopa treatment on reaction-time performance in Parkinson’s disease

et al. 2002

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Basal ganglia-thalamocortical circuits play an important role in movement preparation and execution. Tracer, single-cell, and lesion studies in monkeys suggest the existence of topologically segregated motor and nonmotor basal ganglia cortical circuits. In this study we used deep brain stimulation (DBS) of the posteroventrolateral globus pallidus internus (GPi) in patients with Parkinson's disease to elucidate the function of the GPi in human sensorimotor behavior. This question was investigated by comparing the influence of DBS on patients' performance in various reaction-time tasks that differed with respect to cognitive but not motor requirements. As a main result, DBS improved performance on the different tasks independently of the complexity of the involved cognitive processing functions. Furthermore, the observed effects did not depend on the modality of the processed information. These results suggest that the functional state of the posteroventrolateral GPi selectively affects the motor stage in simple sensorimotor acts, because this stage was the only stage involved in all investigated tasks. In addition to DBS, we manipulated the levodopa medication state of the PD patients. In contrast to DBS, levodopa effects on reaction times were less consistent. Levodopa improved reaction times in choice reaction tasks significantly, while affecting reaction times in a simple reaction task to a lesser extent. Error analysis revealed that the medication-dependent reaction-time improvement in the choice reaction tasks was accompanied by an increase in errors, suggesting a shift of the speed-accuracy criteria of the patients. A similar pattern of results was not observed for the DBS effects. Taken together, our data are in agreement with recent findings in monkeys that indicate a topological organization of the GPi in which motor functions are localized in posterolateral regions apart from cognitive regions. Furthermore, our data show a way to uncover the subcortical-cortical circuitry serving human sensorimotor behavior.

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Section: Neuroanatomical Interpretationmentioning

confidence: 98%

Effects of pallidal deep brain stimulation and levodopa treatment on reaction-time performance in Parkinson’s disease

et al. 2002

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“…102 However, Durif et al; reported that stimulation of the anteromedial GPi led to results similar to that induced by posteroventral GPi stimulation. 103 Studies of GPi stimulation with chronic implanted quadripolar electrodes showed variable and sometimes opposite effects by using different electrical poles located only 1.5 mm apart from each other. The therapeutic window seemed narrow between, on the one hand, the improvement in akinesia in off-drug conditions and, on the other hand, the aggravation in akinesia by the inhibition of levodopa action, [104][105][106] whereas at the same site rigidity remained improved and levodopa-induced dyskinesias were almost totally suppressed.…”

Section: P Pollak Et Al S78mentioning

confidence: 99%

Treatment results: Parkinson's disease

et al. 2002

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Deep brain stimulation (DBS) is a neurosurgical treatment of Parkinson's disease that is applied to three targets: the ventral intermediate nucleus of the thalamus (Vim), the globus pallidus internas (GPi) and the subthalamic nucleus (STN). Vim DBS mainly improves contralateral tremor and, therefore, is being supplanted by DBS of the two other targets, even in patients with tremor dominant disease. STN and GPi DBS improve off-motor phases and dyskinesias. There is little comparative data between these procedures. The magnitude of the motor improvement seems more constant with STN than GPi DBS. STN DBS allows a decrease in antiparkinsonian drug doses and consumes moderate current. These advantages of STN over GPi DBS are offset by the need for more intensive postoperative management. The DBS procedure has the unique advantage of reversibility and adjustability over time. Patients with young-onset Parkinson's disease suffering from levodopa-induced motor complications but still responding well to levodopa and who exhibit no behavioral, mood, or cognitive impairment benefit the most from STN DBS. Adverse effects more specific of the DBS procedure are infection, cutaneous erosion, and lead breaking or disconnection. Intracranial electrode implantation can induce a hematoma or contusion. Most authors agree that the benefit to risk ratio of DBS is favorable.

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“…In studies in which DBS has been performed for PD, the lead location has varied widely, from posterolateral locations similar to Leksell's pallidotomy target to much more anteromedial placements. 2,11,27,40 In our series, the mean lead tip location was 19.9 mm lateral, 2.5 mm anterior, and 5.8 mm inferior to the midcommissural point, generally close to the dorsolateral border of the optic tract. Active electrodes were clustered near the axial plane of the commissures in the lateral part of the motor territory of the GPi, 3 to 5 mm from the pallidocapsular border.…”

Section: Location Of the Active Electrodementioning

confidence: 99%

Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes

Starr¹,

Turner²,

Rau³

et al. 2004

FOC

103

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Object Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a promising new procedure for the treatment of dystonia. The authors present their technical approach for placement of electrodes into the GPi in awake patients with dystonia, including the methodology used for electrophysiological mapping of the GPi in the dystonic state, clinical outcomes and complications, and the location of electrodes associated with optimal benefit. Methods Twenty-three adult and pediatric patients who had various forms of dystonia were included in this study. Baseline neurological status and improvement in motor function resulting from DBS were measured using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Implantation of the DBS lead was performed using magnetic resonance (MR) imaging–based stereotaxy, single-cell microelectrode recording, and intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects. Electrode locations were measured on computationally reformatted postoperative MR images according to a prospective protocol. Conclusions Physiologically guided implantation of DBS electrodes in patients with dystonia is technically feasible in the awake state in most cases, with low morbidity rates. Spontaneous discharge rates of GPi neurons in dystonia are similar to those of globus pallidus externus neurons, such that the two nuclei must be distinguished by neuronal discharge patterns rather than by rates. Active electrode locations associated with robust improvement (> 50% decrease in BFMDRS score) were located near the intercommissural plane, at a mean distance of 3.7 mm from the pallidocapsular border. Patients with juvenile-onset primary dystonia and those with the tardive form benefited greatly from this procedure, whereas benefits for most secondary dystonias and the adult-onset craniocervical form of this disorder were more modest.

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Acute and chronic effects of anteromedial globus pallidus stimulation in Parkinson's disease

Cited by 40 publications

References 39 publications

Effects of pallidal deep brain stimulation and levodopa treatment on reaction-time performance in Parkinson’s disease

Effects of pallidal deep brain stimulation and levodopa treatment on reaction-time performance in Parkinson’s disease

Treatment results: Parkinson's disease

Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes

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