Pallidotomy for generalized dystonia

Ondo, William G.; Desaloms, J. Michael; Jankovic, Joseph; Grossman, Robert G.

doi:10.1002/mds.870130415

Cited by 204 publications

(138 citation statements)

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“…Our patients showed a progressive improvement up to three months (case 4 up to six months), as reported in other series [13][14][15] . One remarkable exception was case 1, who had a marked improvement in the immediate post-operative period and relapsed three months later 16 .…”

Section: Discussionsupporting

confidence: 89%

“…One remarkable exception was case 1, who had a marked improvement in the immediate post-operative period and relapsed three months later 16 . This might be due to an imperfect lesion placement, in the same way as reported for Parkinson's disease and its dyskinesias and other dystonic patients 14,[18][19][20] . The lack of microelectrode recording may further compromise a perfect placement of the lesion [18][19][20][21] .…”

Section: Discussionmentioning

confidence: 86%

“…The reason why it took three months to relapse raises some questions; the posttraumatic group may not be amenable to this procedure; Ondo and colleagues reported a poorer result also in a patient with posttraumatic dystonia, although there was no history of relapse. Lesion placement do not seem to be an issue 14 . The fact behind the immediate improvement in this particular patient also remains to be explained; differences in pathophysiology of diverse subgroups of dystonia may explain the observed differences of benefit/relapse and the different time patterns.…”

Section: Discussionmentioning

confidence: 99%

“…The fact behind the immediate improvement in this particular patient also remains to be explained; differences in pathophysiology of diverse subgroups of dystonia may explain the observed differences of benefit/relapse and the different time patterns. Besides that, it seems that all subgroups of dystonias may benefit with pallidotomies, even the paroxistics and that ones related to progressive neurodegenerative diseases 14,15,[21][22][23] .…”

Section: Discussionmentioning

confidence: 99%

“…The growing experience with pallidal lesions for Parkinson's disease shows frequent improvement of all kind of dyskinesias/dystonias, including the ones not related to L-Dopa therapy [3][4][5][6][7][8][9][10][11] . These findings, along with some recent reports of marked improvement in medically refractory dystonias prompted us to evaluate the effectiveness of this procedure in a group of selected patients [12][13][14][15][16] .…”

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confidence: 99%

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Bilateral pallidotomy for generalized dystonia

Teive

Sá

Grande

et al. 2001

Arq. Neuro-Psiquiatr.

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-Objective: To evaluate the efficacy and safety of bilateral pallidotomies in five patients with generalized dystonia. Background: Generalized dystonias are frequently a therapeutic challenge, with poor responses to pharmacological treatment. GPi (globus pallidus internus) pallidotomies for Parkinson's disease ameliorate all kinds of dyskinesias/dystonia, and recent studies reported a marked improvement of refractory dystonias with this procedure. Methods: Five patients with generalized dystonias refractory to medical treatment were selected; one posttraumatic and four idiopathic. The decision to perform bilateral procedures was based on the predominant axial involvement in these patients. Dystonia severity was assessed with the Burke-FahnMarsden Dystonia Scale (BFM). Simultaneous procedures were performed in all but one patient, who had a staged procedure. They were reevaluated with the same scale (BFM) by an unblinded rater at 1, 2, 3, 30, 60, 90, 120 and 180 days post-operatively. Results: The four patients with idiopathic dystonia showed a progressive improvement up to three months; the patient with posttraumatic dystonia relapsed at three months. One patient had a marked improvement, being able to discontinue all the medications. A mean decrease in the BFM scores of 52,58% was noted. One patient had a trans-operative motor seizure followed by a transient hemiparesis secondary to rack hemorrhage; other was lethargic up to three days after the procedure. Conclusions: Our results show that bilateral GPi pallidotomies may be a safe and effective approach to medically refractory generalized dystonias; it can also be speculated that the posttraumatic subgroup may not benefit with this procedure.KEY WORDS: dystonia, pallidotomy, stereotactic surgery. Palidotomia bilateral para distonias generalizadasRESUMO -As distonias generalizadas são freqüentemente um desafio terapêutico, com pobres respostas aos tratamentos farmacológicos. As cirurgias estereotáxicas, como a palidotomia, têm sido utilizadas com êxito no tratamento da doença de Parkinson e estudos recentes relatam importante melhora das distonias generalizadas, refratárias ao tratamento farmacológico, com a palidotomia bilateral. O objetivo dos autores foi avaliar a eficácia e segurança da palidotomia bilateral em cinco pacientes com distonia generalizada. Foram selecionados cinco pacientes com distonia generalizada, predominante axial, refratários ao tratamento farmacológico (quatro idiopáticas e uma pós-traumática). A severidade da distonia foi avaliada através da escala de Burke-Fahn-Marsden (BFM), no 1º, 2º, e 3º dia após a cirurgia e nos dias 30, 60, 90, 120 e 180 do pós-operatório. Quatro pacientes com distonia idiopática tiveram uma progressiva melhora dentro de 3 meses após a cirurgia e o paciente com distonia pós-traumática teve uma piora da distonia após 3 meses da cirurgia. Um dos pacientes teve uma melhora acentuada do quadro de distonia, ficando livre das medicações. Em média ocorreu redução de 52,58 % dos escores da escala de BFM. Um dos...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Bilateral pallidotomy for generalized dystonia

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Grande

et al. 2001

Arq. Neuro-Psiquiatr.

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Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus

et al. 1999

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Microelectrode recording was performed in the basal ganglia of 3 patients with generalized dystonia and 1 patient with hemiballismus secondary to a brainstem hemorrhage. Neuronal activity was recorded from the internal and external segments of the globus pallidus and assessed for mean discharge rate and pattern of spontaneous activity. The responses of neurons in the internal segment of the globus pallidus to passive and active movements were also evaluated. Mean discharge rates of neurons in both segments of the pallidum in patients with dystonia and the patient with hemiballismus were considerably lower than those reported for patients with idiopathic Parkinson's disease. In addition, the pattern of spontaneous neuronal activity was highly irregular, occurring in intermittent grouped discharges separated by periods of pauses. Although receptive fields in the dystonia patients were widened and less specific than those reported in normal monkeys, neuronal responses to movement were uncommon in the hemiballismus patient. Before surgery, patients with dystonia experienced abnormal posturing and involuntary movements. Coactivation of agonist–antagonist muscle groups was observed both at rest and during the performance of simple movements. After pallidotomy there was a significant reduction in the involuntary movement associated with these disorders and a more normal pattern of electromyographic activity during rest and movement. Given the improvement in dystonic and hemiballistic movements in these patients after ablation of the sensorimotor portion of the internal segment of the globus pallidus, we suggest that pallidotomy can be an effective treatment for patients with dystonia and also for patients with medically intractable hemiballismus. Based on the finding of decreased neuronal discharge rates in pallidal neurons, we propose that physiologically dystonia most closely resembles a hyperkinetic movement disorder. A model for dystonia is proposed that incorporates the observed changes in the rate and pattern of neuronal activity in the pallidum with data from neuroimaging with positron emission tomography and 2‐deoxyglucose studies. Ann Neurol 1999;46:22–35

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Pallidotomy and generalized dystonia

Lin

Chang

1999

Mov. Disord.

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Pallidotomy for generalized dystonia

Cited by 204 publications

References 30 publications

Bilateral pallidotomy for generalized dystonia

Bilateral pallidotomy for generalized dystonia

Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus

Pallidotomy and generalized dystonia

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