Pallidotomy for Parkinson disease: a review of contemporary literature

Alkhani, Ahmed; Lozano, Andrés M.

doi:10.3171/jns.2001.94.1.0043

Cited by 124 publications

(63 citation statements)

References 84 publications

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“…Horak and Anderson (1984) and Mink and Thatch (1993) observed that monkeys with lesions causing increased activity within the GPi exhibited significant motor slowing. The therapeutic effects of surgical disruption of the output of the GPi in Parkinson disease are also consistent with this model (Pfann et al, 1998;Alkhani and Lozano, 2001;Lozano and Lang, 2001;Dostrovsky et al, 2002).…”

Section: Neuroanatomy and Chemistry Of The Subcortical Motor Systemsupporting

confidence: 65%

Do Preclinical Findings of Methamphetamine-Induced Motor Abnormalities Translate to an Observable Clinical Phenotype?

Caligiuri

Buitenhuys

2005

Neuropsychopharmacol

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This review summarizes the preclinical literature of the effects of methamphetamine (MA) on subcortical dopaminergic and GABAergic mechanisms underlying motor behavior with the goal of elucidating the clinical presentation of human MA-induced movement disorders. Acute and chronic MA exposure in laboratory animal can lead to a variety of motor dysfunctions including increased locomotor activity, stereotypies, diminished or enhanced response times, and parkinsonian-like features. With the exception of psychomotor impairment and hyperkinesia, MA-induced movement disorders are not well documented in humans. This review attempts to draw parallels between the animal and human changes in basal ganglia neurochemistry associated with MA exposure and offers explanations for why a parkinsonian phenotype is not apparent among individuals who use and abuse MA. Significant differences in the expression of neurotoxicity and presence of multiple environmental and pharmacologic confounds may account for the lack of a parkinsonian phenotype in humans despite evidence of altered dopamine function.

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Section: Neuroanatomy and Chemistry Of The Subcortical Motor Systemsupporting

confidence: 65%

Do Preclinical Findings of Methamphetamine-Induced Motor Abnormalities Translate to an Observable Clinical Phenotype?

Caligiuri

Buitenhuys

2005

Neuropsychopharmacol

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“…The risk of haemorrhagic complication is higher when using MER, which was confi rmed by studies (10,8), where there was a signifi cantly higher incidence of haemorrhage in centres using microelectrodes compared to the centres, which did not use them. Other studies found 4-5 times higher risk of haemorrhage with using MER (16).…”

Section: Discussionsupporting

confidence: 57%

“…The incidence of haemorrhagic complications is found in literature in the review studies (10,11) as well as in studies with a higher number of patients (12,13,7,14). The average incidence of haemorrhagic complications is 5 %, asymptomatic in 1.9 %, symptomatic in 2.1 % and resulting in permanent defi cit or death in 1 %.…”

Section: Discussionmentioning

confidence: 81%

Prevalent placement error of deep brain stimulation electrode in movement disorders (technical considerations)

Kloc¹,

Košutzká²,

Štěňo³

et al. 2017

BLL

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BACKGROUND: Deep brain stimulation is an effective and safe technique. Displacement of the electrode relative to the optimal stimulation site can lead to insuffi cient effect and sometimes to the need of operative electrode re-position. OBJECTIVE: This study was aimed to analyse targeting accuracy of deep brain stimulation electrode implantation to subthalamic nucleus (STN) and globus pallidus internus (Gpi). It detected possible causes of inaccuracy and prevalent shift to certain direction. METHODS: Targeting accuracy was analysed in 47 patients with Parkinson´s disease (PD) and 11 patients with dystonia with bilateral implantation of deep brain stimulation electrodes between years 2009 and 2016. RESULTS: A shift of electrode to prevalent direction was observed on the left side to medial and posterior and on the right side to lateral direction. Greater shift was observed on the left side and in a higher angulation of trajectory laterally. Movement of the electrode, because of its traction in anchoring device, was identifi ed as a possible factor for prevalent electrode shift. Calibration of stereotactic coordinates to correct prevalent shift was used. CONCLUSION: Targeting inaccuracy is the result of accumulation of errors in individual steps of electrode implantation. Direction of the shift can be random or it can be toward a prevalent direction. A correction of prevalent error can prevent a suboptimal electrode placement (Tab. 3, Fig. 11, Ref. 29). Text in PDF www.elis.sk.

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“…In the latter, the following were found: dysarthria (3.6%), visual field defect (2.4%), facial weakness (2.4%), hypophonia (1.2%), dysphagia (2.4%), personality changes (3.9%), and hypersalivation (2.1%). In most instances, the rates from the prospective series are higher than those shown by the Alkhani and Lozano 57 analysis. The effects of technical issues on complications were assessed with respect to the use of microelectrode mapping, but the effect of location along the learning curve could not be assessed by either study.…”

Section: Is Posteroventral Pallidotomy a Safe Therapy For Pd?mentioning

confidence: 68%

“…How often and how severe are the adverse effects from pallidotomy, and how do they compare to DBS? From a literature survey covering 1510 patients, Alkhani and Lozano 57 found a rate of persistent (Ͼ3 months) adverse effects of 14.3%, including symptomatic infarction or hemorrhage (1.7%), dysarthria (1.6%), visual field defect (1.5%), facial weakness (1.3%), hypophonia (1.3%), and dysphagia (0.5%). These rates may be confounded by being derived mostly from retrospective data sets, and representing centers with varying technical proficiency with the operation, which may have counteracting effects.…”

Section: Is Posteroventral Pallidotomy a Safe 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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Pallidotomy for Parkinson disease: a review of contemporary literature

Abstract: Unilateral pallidotomy is effective and relatively safe in the treatment of PD; however, limited data are available on the long-term outcome of this procedure.

Cited by 124 publications

References 84 publications

Do Preclinical Findings of Methamphetamine-Induced Motor Abnormalities Translate to an Observable Clinical Phenotype?

Do Preclinical Findings of Methamphetamine-Induced Motor Abnormalities Translate to an Observable Clinical Phenotype?

Prevalent placement error of deep brain stimulation electrode in movement disorders (technical considerations)

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

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