The Mode of Innervation FoIIowing Thalamotomy and Subthalamotomy

Strüppler, A.; Burg, Doris; Lücking, Carl Hermann; Velho, Fábio Michalski

doi:10.1159/000102811

Cited by 7 publications

(5 citation statements)

References 4 publications

(4 reference statements)

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“…13,74,102,146 During the lesioning era, the target for subthalamotomy was not the STN as it is today. In fact, authors performed their lesioning in the zona incerta (Zi), 14,112,113 the subventrolateral thalamus, 116 the posterior subthalamic area, and the Raprl (prelemniscal radiations) 24,75,82,173 or H 2 Field of Forel (lenticular fasciculus), 14,76,77,106,113,154,155 all under the term "subthalamotomy," while others coined the term "campotomy." 152 However, none of these authors targeted the STN itself.…”

Section: History Of Subthalamotomymentioning

confidence: 99%

“…On the other hand, since precise imaging and electrophysiological data were scarce, if not completely lacking at that time, it is difficult to compare these publications with current subthalamotomy knowledge. In the 1960s and 1970s, lesioning in the subthalamic area was not restricted to PD treatment, but was also used for the treatment of tremor, 82,173 cerebral palsy, 82,94 and hyperkinetic movements, 116 including dystonia, 155 intractable spasms, 82,155 athetosis, 119,155 hemiballismus, 11,12 and dyskinesia.…”

Section: History Of Subthalamotomymentioning

confidence: 99%

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Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

Jourdain

Schechtmann

Paolo

2014

JNS

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Parkinson's disease (PD) is a neurodegenerative condition that can be pharmacologically treated with levodopa. However, important motor and nonmotor symptoms appear with its long-term use. The subthalamic nucleus (STN) is known to be involved in the pathophysiology of PD and to contribute to levodopa-induced complications. Surgery is considered in patients who have advanced PD that is refractory to pharmacotherapy and who display disabling dyskinesia. Deep brain stimulation of the STN is currently the main surgical procedure for PD, but lesioning is still performed. This review covers the clinical aspects and complications of subthalamotomy as one of the lesion-based options for PD patients with levodopa-induced dyskinesias. Moreover, the authors discuss the possible effects of subthalamic lesioning.

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Section: History Of Subthalamotomymentioning

confidence: 99%

Section: History Of Subthalamotomymentioning

confidence: 99%

Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

Jourdain

Schechtmann

Paolo

2014

JNS

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“…It should also be noted that lesions placed in the thalamus during movement disorder surgery were found to vary by as much as 7 mm and depended on the judgment of individual surgical teams as well as differing approaches to targeting and target verification 136. Struppler and colleagues137 argued that the best effects were obtained with lesions in the region below the thalamus.…”

Section: Controversy: What Is the Optimal Lesion Site Within The Strumentioning

confidence: 99%

“…An argument could be made, therefore, that lesioning different subnuclei of the motor thalamus could have different beneficial effects, including tremor relief from a Vim lesion, rigidity relief from a lesion of Vop, and akinesia relief from a lesion in Voa. Although there is some clinical and anatomical support for this argument,34–36, 137, 140 more studies need to be carried out to validate this supposition.…”

Section: Controversy: What Is the Optimal Lesion Site Within The Strumentioning

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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“…Therefore, the procedure was restricted to the more posteriorly located subthalamic area, close to the posterior commissure and certainly not in the area where the anatomical atlases and the standardised models place the STN [1,7,17]. It is true, that at that time, the methods of imaging did not allow a detailed analysis of the position and size of the surgical lesions; however, microelectrode recordings in and around the target area, indicated that this area consists of a group of fibers with few neurons [5,9].…”

Section: Discussionmentioning

confidence: 99%

Neuromodulation of prelemniscal radiations in the treatment of Parkinson’s disease

Carrillo-Ruíz¹,

Velasco²,

Jiménez³

et al.

Operative Neuromodulation

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SummaryIn patients with Parkinson's disease (PD), tetrapolar electrodes were implanted in the prelemniscal radiations (RAPRL) to treat tremor, rigidity and bradykinesia. Fifteen patients were implanted unilaterally and five patients bilaterally and followed-up for one year. The selection criteria included the presence of unilateral pronounced tremor and rigidity in patients implanted unilaterally or bilateral symptoms including severe bradykinesia in patients implanted bilaterally. In the operating room, the tremor decreased significantly or was abolished following the insertion of the electrode in the RAPRL. This effect was temporary and subsided when the stimulation was off. However, when the stimulator was turned on, the severity of the symptoms and signs decreased significantly. The post-implantation MRI confirmed that the electrode contacts used for stimulation were inserted in RAPRL, a group of fibers located between the red nucleus and subthalamic nucleus, above the substantia nigra, medially to the zona incerta and below the thalamus. The patients were evaluated using the UPDRS part III, before implantation and every 3 months during the first year. Global scores decreased significantly. The pre-and postoperative median values (range in round brackets) were as follows: tremor improved from 3 (2-16) to 1 (2-3) (p < 0.001); rigidity was either abolished or decreased markedly from 2 (1-16) to 0 (0-4) (p < 0.001); bradykinesia improved from 2 (0-4) to 1 (0-2) (p < 0.001). We conclude that RAPRL, an area anatomically different from STN, is a good target for electrical stimulation in order to treat effectively all the main symptoms of PD.

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The Mode of Innervation FoIIowing Thalamotomy and Subthalamotomy

Cited by 7 publications

References 4 publications

Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

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

Neuromodulation of prelemniscal radiations in the treatment of Parkinson’s disease

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