What Happened to VIM Thalamotomy for Parkinson's Disease?

Tasker, R. R.; Siqueira, José F.; Hawrylyshyn, P.; Organ, L.W.

doi:10.1159/000101245

Cited by 65 publications

(60 citation statements)

References 5 publications

(5 reference statements)

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“…This side effect has been observed following lesions of the thalamus, 15,19,20,49 the pallidum, 16,17,30,50,51 and the STN. 14,18,31 In these cases, worsening of speech may be explained by the proximity of the corticobulbar fibers to surgical targets.…”

Section: Discussionmentioning

confidence: 94%

“…This is most likely because of the proximity of all three targets to the corticobulbar fibers. Deep brain stimulation (DBS) of the thalamus was introduced to avoid the side effects 20,21 induced by the lesion, 22 but VIM stimulation has also been shown to induce a worsening of speech. 23 As stimulation parameters can be adjusted, exacerbation of dysarthria following VIM stimulation would generally not be severe.…”

Section: Abstract: Levodopa (L-dopa) and Subthalamic Nucleus (Stn) Stmentioning

confidence: 99%

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Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

et al. 2005

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Levodopa (L‐dopa) and subthalamic nucleus (STN) stimulation treatments have been associated with both improvement and exacerbation of dysarthria in Parkinson's disease (PD). We report four cases illustrating variant responses of dysarthria to dopaminergic and STN stimulation therapies. Patients' motor disability and dysarthria were perceptually rated by the Unified Parkinson's Disease Rating Scale (UPDRS) in four conditions according to medication and STN stimulation. Dedicated software packages allowed acquisition and analysis of acoustic recordings. Case 1, who had a severe off period aphonia, experienced improvement of speech induced by both levodopa and STN stimulation. In Case 2, both treatments worsened speech due to the appearance of dyskinesias. Case 3 had a dysarthria exacerbation induced by STN stimulation with parameters above optimal levels, interpreted as current diffusion from the STN to corticobulbar fibers. In Case 4, dysarthria exacerbation occurred with stimulation at an electrode contact located caudally to the target, also arguing for current diffusion as a potential mechanism of speech worsening. The presented cases demonstrated variant effects in relation to L‐dopa and STN stimulation on speech. It seems that motor speech subcomponents can be improved like other limb motor aspect, but that complex coordination of all speech anatomical substrates is not responsive to STN stimulation. These hypotheses may be helpful for better understanding and management of STN stimulation effects on motor speech and skeleton–motor subsystems. © 2005 Movement Disorder Society

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Section: Discussionmentioning

confidence: 94%

Section: Abstract: Levodopa (L-dopa) and Subthalamic Nucleus (Stn) Stmentioning

confidence: 99%

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

et al. 2005

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“…Data collection was retrospective (Class III). Thalamotomy is not effective for treatment of bradykinesia, micrographia, or difficulty with gait or speech, 97 but targeted to the ventral oral posterior nucleus it may have value for rigidity and dyskinesia. 98 We will emphasize the operation directed to the Vim target here.…”

Section: Thalamotomymentioning

confidence: 99%

Evaluation of surgery for Parkinson’s disease

Hallett¹,

Litvan²

1999

Neurology

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the Task Force on Surgery for Parkinson's Disease* PD is a common disorder affecting on average 100 per 100,000 population. Despite the large number of medications available for the treatment of early and moderately advanced PD, options specifically designed for the patient with advanced disease are limited. Surgery for PD dates from 1939-1940, when Bucy and Case 1 and Klemme 2 excised parts of the cerebral cortex to treat tremor and dystonia, but this type of surgery produced hemiparesis. Surgical basal ganglia lesions were introduced a few years later by Meyers, 3,4 who found that pallidotomy produced significant relief of tremor, rigidity, and dyskinesias, but with considerable mortality. Stereotaxic techniques to coagulate the globus pallidus in PD were introduced in the 1950s by Spiegel and Wycis, 5,6 and Cooper was an early advocate of pallidal surgery.7 Based on the anatomic connections between the pallidum and the thalamus, Hassler introduced the concept of surgery on the ventrolateral nucleus of the thalamus. 8,9Microelectrode recording allowed Narabayashi 10,11 to find that lesioning the ventral intermediate (Vim) nucleus of the thalamus was the most specific target to control the tremor in PD. Neurosurgery reached its peak in the 1960s, but declined after the introduction of levodopa.The recent resurgence of surgery was initiated by adrenal medullary transplantation. The premise of adrenal medullary transplants was that these cells, when transplanted into patients with advanced PD, would survive and function as a new source of dopamine. The theoretical advantages of adrenal tissue include that the tissue comes from the patient, eliminating the issue of immunologic rejection; dopamine is a normal intermediate compound made by the chromaffin cells; and chromaffin cells may have neuritic morphology when grown in culture. The disadvantages include the non-neuronal source and the rather modest survival rates of cells in laboratory transplantation studies. Isolated case reports of effective treatment of advanced PD with unilateral transplantation of adrenal medullary cells into the striatum in the 1980s led to several clinical trials testing the safety and efficacy of this procedure.Fetal mesencephalon transplantation was introduced subsequently and is based on several considerations. First, PD is associated with relatively selective degeneration of dopaminergic cells located in the substantia nigra, a portion of the mesencephalon. Second, replacement of dopaminergic activity by means of precursor drugs, receptor agonists, or inhibitors of dopamine catabolism improves the signs and symptoms of PD. Third, laboratory evidence in experimental animals has demonstrated that grafts of dopamine-containing neurons improve behavioral models of PD. Fourth, in these animal models, grafts reinnervate the striatum and form synaptic connections with host neurons. As a result, a small number of research teams have developed programs for human fetal mesencephalic cell grafts in PD patients. Several published reports exist,...

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“…1,2 Stereotactic surgery, such as radiofrequency thermocoagulation (RFT) or deep brain stimulation (DBS), may be a therapeutic option. [3][4][5] DBS has supplanted RFT as the reference technique because of its efficacy, potential reversibility, adaptability, and safety even when performed bilaterally. 2,[6][7][8][9][10][11] However, both RFT and DBS may carry significant risks including intracerebral hemorrhage, infection, and hardware-related complications.…”

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confidence: 99%

A prospective single-blind study of Gamma Knife thalamotomy for tremor

et al. 2015

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Objective: To evaluate the safety and efficacy of unilateral Gamma Knife thalamotomy (GKT) for treatment of severe tremor with a prospective blinded assessment.Methods: Fifty patients (mean age: 74.5 years; 32 men) with severe refractory tremor (36 essential, 14 parkinsonian) were treated with unilateral GKT. Targeting of the ventral intermediate nucleus (Vim) was achieved with Leksell Gamma Knife with a single shot through a 4-mm collimator helmet. The prescription dose was 130 Gy. Neurologic and neuropsychological assessments including a single-blinded video assessment of the tremor severity performed by a movement disorders neurologist from another center were performed before and 12 months after treatment. MRI follow-up occurred at 3, 6, and 12 months. Results:The upper limb tremor score improved by 54.2% on the blinded assessment (p , 0.0001). All tremor components (rest, postural, and intention) were improved. Activities of daily living were improved by 72.2%. Cognitive functions remained unchanged. Following GKT, the median delay of improvement was 5.3 months (range 1-12 months). The only side effect was a transient hemiparesis associated with excessive edema around the thalamotomy in one patient. Conclusion:This blinded prospective assessment demonstrates that unilateral GKT is a safe and efficient procedure for severe medically refractory tremor. Side effects were rare and transient in this study. Classification of evidence:This study provides Class IV evidence that for patients with severe refractory tremor, GKT is well tolerated and effective in reducing tremor impairment. The pharmacologic treatment for severe tremor can be disappointing.

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What Happened to VIM Thalamotomy for Parkinson's Disease?

Cited by 65 publications

References 5 publications

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

Evaluation of surgery for Parkinson’s disease

A prospective single-blind study of Gamma Knife thalamotomy for tremor

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