Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1‐year results of a pilot study

Abstract

The effects of posterior internal pallidal ablation (GPi pallidotomy) on parkinsonian signs and symptoms were studied in 15 patients with medically intractable Parkinson's disease (PD). The sensorimotor territory of the internal portion of the globus pallidus and the adjacent optic tract and internal capsule were identified with microelectrode recording and stimulation. Radiofrequency lesions were then created in the identified sensorimotor territory. Pallidotomy significantly improved all cardinal parkinsonian motor signs (tremor, rigidity, akinesia/bradykinesia, and gait dysfunction) and reduced drug-induced motor fluctuations and dyskinesias. The improvements occurred predominately contralateral to the lesion, but were also present ipsilaterally. Early postoperative (3-month), mean total United Parkinson's Disease Rating Scale scores improved by 30.1% from preoperative values. Mean combined "on/off" Schwab and England Scale scores, a measure of functional independence, increased from 48.8% to 73.0% postoperatively. The mean total United Parkinson's Disease Rating Scale and Schwab and England scores did not show a statistically significant decline over the 1-year postoperative period. Surgery resulted in little morbidity, including a lack of significant deficits on neuropsychological and psychiatric testing. Physical and social functioning and vitality measures on the Medical Outcome Scale also showed significant improvement over the postoperative period. The findings of this pilot study demonstrate that ablation of the sensorimotor portion of the internal pallidum is a highly effective treatment for advanced PD, with benefits sustained at 1 year.

Acoustic voice assessment in Parkinson's disease patients submitted to posteroventral pallidotomy

“…The UPDRS (Part IIImotor score) was used because it allows data comparisons between different studies, as it is a widely used scale. The mean UPDRS score was lower after PVP, which is in accordance with the literature 5,11,14 . The different studies that reported neurological evaluations in the off and on phase observed an improvement only in the off phase 5,11,[14][15][16] .…”

“…The mean UPDRS score was lower after PVP, which is in accordance with the literature 5,11,14 . The different studies that reported neurological evaluations in the off and on phase observed an improvement only in the off phase 5,11,[14][15][16] . Ondo et al 14 speculated that the improvement in the off phase is consistent with the traditional model of the basal ganglia physiology in PD, which determines the presence of tonic thalamic hypo activity resulting from the excessive inhibition induced by the internal palladium.…”

“…There is an intimate relationship between F0 and vocal intensity; although increases in intensity are measured by greater glottal coaptation and activity of the respiratory mechanism, variations in intensity are dependent on the frequency and vice-versa. Regarding the evaluation of vocal intensity, some studies described a reduction in loudness after PVP 5,8,15, while Laitinen et al 6 observed an increase. Schulz et al 8 did not observe a correlation between the increase of F0 and the increase in vocal intensity.…”

“…Pos-teroventral pallidotomy can improve the cardinal motor signals, and also reduce dyskinesias and drugrelated motor fluctuations 5,6 . Buck and Cooper 7 studied the speech after chemopallidectomy or occlusion of the anterior coroid artery, and observed a reduction of the diadochokinetic rate of the vocal folds.…”

Avaliação das atividades da vida diária dos pacientes com doença de Parkinson submetidos a cirurgia estereotáxica

“…Estes resultados assemelham-se aos de outros estudos realizados, em que também não houve mudança estatisticamente significante na dose de levodopa 3,4,6,16,[26][27][28] . Na análise realizada por Masterman et al, que avaliaram pacientes parkinsonianos submetidos a palidotomia unilateral no 3º e 6º mês pós-operatório, 44% dos pacientes mantiveram a mesma dose de levodopa, 41% tiveram a dose diminuída e 15% necessitaram de aumento na dose de levodopa 5 .…”