Chronic anterior pallidal stimulation for parkinson's disease

Abstract

We present the case of a 51-year-old female who had a four-year history of Parkinson's disease with severe "on-off' and disabling progression of symptoms on chronic levodopa therapy. After obtaining FDA approval, we implanted a Medtronic deep brain stimulation lead stereotactically into the right anterior pallidum contralateral to her most symptomatologic side. Intra-operative stimulation trials at 100 Hz caused reproducible reversal of akinetic symptoms and simultaneous microelectrode recording of the posteroventral pallidum revealed decreased neural activity during anterior pallidal stimulation. The patient was evaluated pre-operatively and postoperatively using the Hoehn and Yahr Staging Scale, the Unified Parkinson's Disease Rating Scale (UPDRS), videotape, and a computerized data glove. Six months after implantation, the total UPDRS score was decreased from 68 to 8 and Hoehn and Yahr Staging improved from 3.0 to 1.5 during periods of chronic high frequency stimulation. Dramatic improvements in tremor, dystonia, bradykinesia, and akinesia were noted within seconds of stimulator activation and were also objectively measured using a computerized data glove. This case reveals the potential for therapeutic pallidal stimulation for Parkinson's akinetic symptomatology.

The Surgical Treatment of Parkinson’s Disease

“…The pallidum (GPi) has become a target for DBS based on the effectiveness of pallidotomy in treating PD symptoms. Results of unilateral and bilateral GPi stimulation parallel those reported for pallidotomy in terms of beneficial effects (27,39,(45)(46)(47)(48)(49)(50)(51)(52). Rigidity, tremor, bradykinesia, gait, and time spent in the "on" state of drug effectiveness improve.…”

Core assessment program for surgical interventional therapies in Parkinson's disease (CAPSIT-PD)

“…14 Subsequent developments in functional neurosurgery have led to the emergence of pallidotomy [15][16][17] and deep brain stimulation (DBS) in the Gpi and the STN. [18][19][20][21] The demand for a common evaluation protocol was the same for investigators using these techniques as had been applied already within the transplantation program. This led members of the NECTAR network, in 1996, to apply for a grant within the Biomed 2 program for a project entitled "Neurosurgical Interventions in Parkinson's Disease" (NIPD) with two main goals: to propose a new assessment program for all kinds of surgical interventional therapies in PD, and to organize a European registry of operated patients, regardless of which surgical technique was used.…”

Reply to ‘Comment on “A systematic review of the efficacy of globus pallidus stimulation in the treatment of Parkinson’s disease”’

“…This was also shown by Iacono et al when they compared acute and chronic stimulation of the anterior and posterior pallidum, which resulted in statistically significant improvements in rigidity, bradykinesia and dyskinesias for patients with PD. 11,12 We clearly state in the manuscript that the number of articles that investigate the anteroventral portion of the GPi is ''very small" (n = 2). As previously mentioned by Dr Zrinzo, the anterior portion of the pallidum is used currently as a target for Tourette syndrome, but it has also been used to treat PD, with positive results.…”