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. 2002 Oct;73(4):395–399. doi: 10.1136/jnnp.73.4.395

Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson's disease

T Loher 1, J Burgunder 1, S Weber 1, R Sommerhalder 1, J Krauss 1
PMCID: PMC1738057  PMID: 12235307

Abstract

Objective: To investigate the efficacy of chronic pallidal deep brain stimulation (DBS) on off period dystonia, cramps, and sensory symptoms in advanced Parkinson's disease (PD).

Methods: 16 patients (6 women, 10 men; mean age at surgery 65 years) suffering from advanced PD were followed up prospectively for one year after implantation of a monopolar electrode in the posteroventral lateral globus pallidus internus. Unilateral DBS was performed in 9 patients. 10 patients had bilateral procedures (contemporaneous bilateral surgery in 7 and staged bilateral surgery in 3 instances). The decision whether to perform unilateral or bilateral surgery depended on the clinical presentation of the patient. Patients were formally assessed preoperatively, at 3–5 days, 3 months, and 12 months after surgery.

Results: In patients who underwent unilateral surgery, pain was present in 7 (78%), off dystonia in 5 (56%), cramps in 6 (67%), and dysaesthesia in 4 (44%). In patients who underwent bilateral surgery, pain was present in 7 (70%), off dystonia in 6 (60%), cramps in 7 (70%), and dysaesthesia in 4 (40%). With unilateral DBS, contralateral off period dystonia was improved by 100% at 1 year postoperatively, pain by 74%, cramps by 88%, and dysaesthesia by 100%. There was less pronounced amelioration of ipsilateral off period dystonia and sensory symptoms. With bilateral DBS, total scores for dystonia were improved by 86%, for pain by 90%, for cramps by 90%, and for dysaesthesia by 88%. The benefit appeared early at the first evaluation 3–5 days after surgery and was stable throughout the follow up period.

Conclusions: Pallidal DBS yields major improvement of off period dystonia, cramps, and sensory symptoms in patients with advanced PD.

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Selected References

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  1. Alexander G. E., Crutcher M. D. Functional architecture of basal ganglia circuits: neural substrates of parallel processing. Trends Neurosci. 1990 Jul;13(7):266–271. doi: 10.1016/0166-2236(90)90107-l. [DOI] [PubMed] [Google Scholar]
  2. Baron M. S., Vitek J. L., Bakay R. A., Green J., Kaneoke Y., Hashimoto T., Turner R. S., Woodard J. L., Cole S. A., McDonald W. M. Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study. Ann Neurol. 1996 Sep;40(3):355–366. doi: 10.1002/ana.410400305. [DOI] [PubMed] [Google Scholar]
  3. Benabid A. L., Koudsie A., Benazzouz A., Piallat B., Krack P., Limousin-Dowsey P., Lebas J. F., Pollak P. Deep brain stimulation for Parkinson's disease. Adv Neurol. 2001;86:405–412. [PubMed] [Google Scholar]
  4. Benazzouz A., Piallat B., Pollak P., Benabid A. L. Responses of substantia nigra pars reticulata and globus pallidus complex to high frequency stimulation of the subthalamic nucleus in rats: electrophysiological data. Neurosci Lett. 1995 Apr 14;189(2):77–80. doi: 10.1016/0304-3940(95)11455-6. [DOI] [PubMed] [Google Scholar]
  5. Boecker H., Ceballos-Baumann A., Bartenstein P., Weindl A., Siebner H. R., Fassbender T., Munz F., Schwaiger M., Conrad B. Sensory processing in Parkinson's and Huntington's disease: investigations with 3D H(2)(15)O-PET. Brain. 1999 Sep;122(Pt 9):1651–1665. doi: 10.1093/brain/122.9.1651. [DOI] [PubMed] [Google Scholar]
  6. Burchiel K. J., Anderson V. C., Favre J., Hammerstad J. P. Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson's disease: results of a randomized, blinded pilot study. Neurosurgery. 1999 Dec;45(6):1375–1384. doi: 10.1097/00006123-199912000-00024. [DOI] [PubMed] [Google Scholar]
  7. DeLong M. R. Primate models of movement disorders of basal ganglia origin. Trends Neurosci. 1990 Jul;13(7):281–285. doi: 10.1016/0166-2236(90)90110-v. [DOI] [PubMed] [Google Scholar]
  8. Demirci M., Grill S., McShane L., Hallett M. A mismatch between kinesthetic and visual perception in Parkinson's disease. Ann Neurol. 1997 Jun;41(6):781–788. doi: 10.1002/ana.410410614. [DOI] [PubMed] [Google Scholar]
  9. Drory V. E., Inzelberg R., Groozman G. B., Korczyn A. D. N30 somatosensory evoked potentials in patients with unilateral Parkinson's disease. Acta Neurol Scand. 1998 Feb;97(2):73–76. doi: 10.1111/j.1600-0404.1998.tb00613.x. [DOI] [PubMed] [Google Scholar]
  10. Gross R. E., Lozano A. M. Advances in neurostimulation for movement disorders. Neurol Res. 2000 Apr;22(3):247–258. doi: 10.1080/01616412.2000.11740667. [DOI] [PubMed] [Google Scholar]
  11. Honey C. R., Stoessl A. J., Tsui J. K., Schulzer M., Calne D. B. Unilateral pallidotomy for reduction of parkinsonian pain. J Neurosurg. 1999 Aug;91(2):198–201. doi: 10.3171/jns.1999.91.2.0198. [DOI] [PubMed] [Google Scholar]
  12. Huttunen J., Teräväinen H. Pre- and postcentral cortical somatosensory evoked potentials in hemiparkinsonism. Mov Disord. 1993 Oct;8(4):430–436. doi: 10.1002/mds.870080403. [DOI] [PubMed] [Google Scholar]
  13. Jobst E. E., Melnick M. E., Byl N. N., Dowling G. A., Aminoff M. J. Sensory perception in Parkinson disease. Arch Neurol. 1997 Apr;54(4):450–454. doi: 10.1001/archneur.1997.00550160080020. [DOI] [PubMed] [Google Scholar]
  14. Klockgether T., Borutta M., Rapp H., Spieker S., Dichgans J. A defect of kinesthesia in Parkinson's disease. Mov Disord. 1995 Jul;10(4):460–465. doi: 10.1002/mds.870100410. [DOI] [PubMed] [Google Scholar]
  15. Koller W. C. Sensory symptoms in Parkinson's disease. Neurology. 1984 Jul;34(7):957–959. doi: 10.1212/wnl.34.7.957. [DOI] [PubMed] [Google Scholar]
  16. Krack P., Pollak P., Limousin P., Benazzouz A., Deuschl G., Benabid A. L. From off-period dystonia to peak-dose chorea. The clinical spectrum of varying subthalamic nucleus activity. Brain. 1999 Jun;122(Pt 6):1133–1146. doi: 10.1093/brain/122.6.1133. [DOI] [PubMed] [Google Scholar]
  17. Krack P., Pollak P., Limousin P., Hoffmann D., Benazzouz A., Le Bas J. F., Koudsie A., Benabid A. L. Opposite motor effects of pallidal stimulation in Parkinson's disease. Ann Neurol. 1998 Feb;43(2):180–192. doi: 10.1002/ana.410430208. [DOI] [PubMed] [Google Scholar]
  18. Krack P., Pollak P., Limousin P., Hoffmann D., Xie J., Benazzouz A., Benabid A. L. Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease. Brain. 1998 Mar;121(Pt 3):451–457. doi: 10.1093/brain/121.3.451. [DOI] [PubMed] [Google Scholar]
  19. Krauss J. K., Desaloms J. M., Lai E. C., King D. E., Jankovic J., Grossman R. G. Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's disease: postoperative magnetic resonance imaging analysis. J Neurosurg. 1997 Sep;87(3):358–367. doi: 10.3171/jns.1997.87.3.0358. [DOI] [PubMed] [Google Scholar]
  20. Krauss J. K., King D. E., Grossman R. G. Alignment correction algorithm for transformation of stereotactic anterior commissure/posterior commissure-based coordinates into frame coordinates for image-guided functional neurosurgery. Neurosurgery. 1998 Apr;42(4):806–812. doi: 10.1097/00006123-199804000-00070. [DOI] [PubMed] [Google Scholar]
  21. Krauss J. K., Simpson R. K., Jr, Ondo W. G., Pohle T., Burgunder J. M., Jankovic J. Concepts and methods in chronic thalamic stimulation for treatment of tremor: technique and application. Neurosurgery. 2001 Mar;48(3):535–543. doi: 10.1097/00006123-200103000-00015. [DOI] [PubMed] [Google Scholar]
  22. Kumar R., Lang A. E., Rodriguez-Oroz M. C., Lozano A. M., Limousin P., Pollak P., Benabid A. L., Guridi J., Ramos E., van der Linden C. Deep brain stimulation of the globus pallidus pars interna in advanced Parkinson's disease. Neurology. 2000;55(12 Suppl 6):S34–S39. [PubMed] [Google Scholar]
  23. Kumar R., Lozano A. M., Sime E., Halket E., Lang A. E. Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation. Neurology. 1999 Aug 11;53(3):561–566. doi: 10.1212/wnl.53.3.561. [DOI] [PubMed] [Google Scholar]
  24. Laitinen L. V., Bergenheim A. T., Hariz M. I. Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg. 1992 Jan;76(1):53–61. doi: 10.3171/jns.1992.76.1.0053. [DOI] [PubMed] [Google Scholar]
  25. Lang A. E. Surgery for Parkinson disease: A critical evaluation of the state of the art. Arch Neurol. 2000 Aug;57(8):1118–1125. doi: 10.1001/archneur.57.8.1118. [DOI] [PubMed] [Google Scholar]
  26. Lidsky T. I., Manetto C., Schneider J. S. A consideration of sensory factors involved in motor functions of the basal ganglia. Brain Res. 1985 Jun;356(2):133–146. doi: 10.1016/0165-0173(85)90010-4. [DOI] [PubMed] [Google Scholar]
  27. Limousin P., Krack P., Pollak P., Benazzouz A., Ardouin C., Hoffmann D., Benabid A. L. Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med. 1998 Oct 15;339(16):1105–1111. doi: 10.1056/NEJM199810153391603. [DOI] [PubMed] [Google Scholar]
  28. Loher Thomas J., Burgunder Jean-Marc, Pohle Thomas, Weber Sabine, Sommerhalder Regine, Krauss Joachim K. Long-term pallidal deep brain stimulation in patients with advanced Parkinson disease: 1-year follow-up study. J Neurosurg. 2002 May;96(5):844–853. doi: 10.3171/jns.2002.96.5.0844. [DOI] [PubMed] [Google Scholar]
  29. Menon V., Glover G. H., Pfefferbaum A. Differential activation of dorsal basal ganglia during externally and self paced sequences of arm movements. Neuroreport. 1998 May 11;9(7):1567–1573. doi: 10.1097/00001756-199805110-00058. [DOI] [PubMed] [Google Scholar]
  30. Nakashima K., Nitta T., Takahashi K. Recovery functions of somatosensory evoked potentials in parkinsonian patients. J Neurol Sci. 1992 Mar;108(1):24–31. doi: 10.1016/0022-510x(92)90183-l. [DOI] [PubMed] [Google Scholar]
  31. Quinn N. P., Koller W. C., Lang A. E., Marsden C. D. Painful Parkinson's disease. Lancet. 1986 Jun 14;1(8494):1366–1369. doi: 10.1016/s0140-6736(86)91674-0. [DOI] [PubMed] [Google Scholar]
  32. Quinn N., Critchley P., Marsden C. D. Young onset Parkinson's disease. Mov Disord. 1987;2(2):73–91. doi: 10.1002/mds.870020201. [DOI] [PubMed] [Google Scholar]
  33. Rickards C., Cody F. W. Proprioceptive control of wrist movements in Parkinson's disease. Reduced muscle vibration-induced errors. Brain. 1997 Jun;120(Pt 6):977–990. doi: 10.1093/brain/120.6.977. [DOI] [PubMed] [Google Scholar]
  34. Rossini P. M., Traversa R., Boccasena P., Martino G., Passarelli F., Pacifici L., Bernardi G., Stanzione P. Parkinson's disease and somatosensory evoked potentials: apomorphine-induced transient potentiation of frontal components. Neurology. 1993 Dec;43(12):2495–2500. doi: 10.1212/wnl.43.12.2495. [DOI] [PubMed] [Google Scholar]
  35. Sathian K., Zangaladze A., Green J., Vitek J. L., DeLong M. R. Tactile spatial acuity and roughness discrimination: impairments due to aging and Parkinson's disease. Neurology. 1997 Jul;49(1):168–177. doi: 10.1212/wnl.49.1.168. [DOI] [PubMed] [Google Scholar]
  36. Schneider J. S., Diamond S. G., Markham C. H. Deficits in orofacial sensorimotor function in Parkinson's disease. Ann Neurol. 1986 Mar;19(3):275–282. doi: 10.1002/ana.410190309. [DOI] [PubMed] [Google Scholar]
  37. Schneider J. S., Diamond S. G., Markham C. H. Parkinson's disease: sensory and motor problems in arms and hands. Neurology. 1987 Jun;37(6):951–956. doi: 10.1212/wnl.37.6.951. [DOI] [PubMed] [Google Scholar]
  38. Schott G. D. Pain in Parkinson's disease. Pain. 1985 Aug;22(4):407–411. doi: 10.1016/0304-3959(85)90046-6. [DOI] [PubMed] [Google Scholar]
  39. Shulman L. M., Taback R. L., Bean J., Weiner W. J. Comorbidity of the nonmotor symptoms of Parkinson's disease. Mov Disord. 2001 May;16(3):507–510. doi: 10.1002/mds.1099. [DOI] [PubMed] [Google Scholar]
  40. Shulman L. M., Taback R. L., Bean J., Weiner W. J. Comorbidity of the nonmotor symptoms of Parkinson's disease. Mov Disord. 2001 May;16(3):507–510. doi: 10.1002/mds.1099. [DOI] [PubMed] [Google Scholar]
  41. Snider S. R., Fahn S., Isgreen W. P., Cote L. J. Primary sensory symptoms in parkinsonism. Neurology. 1976 May;26(5):423–429. doi: 10.1212/wnl.26.5.423. [DOI] [PubMed] [Google Scholar]
  42. Tandberg E., Larsen J. P., Nessler E. G., Riise T., Aarli J. A. The epidemiology of Parkinson's disease in the county of Rogaland, Norway. Mov Disord. 1995 Sep;10(5):541–549. doi: 10.1002/mds.870100503. [DOI] [PubMed] [Google Scholar]
  43. Traversa R., Pierantozzi M., Semprini R., Loberti M., Cicardi M. C., Bassi A., Stanzione P. N30 wave amplitude of somatosensory evoked potentials from median nerve in Parkinson's disease: a pharmacological study. J Neural Transm Suppl. 1995;45:177–185. [PubMed] [Google Scholar]
  44. Volkmann J., Allert N., Voges J., Weiss P. H., Freund H. J., Sturm V. Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology. 2001 Feb 27;56(4):548–551. doi: 10.1212/wnl.56.4.548. [DOI] [PubMed] [Google Scholar]
  45. Volkmann J., Sturm V., Weiss P., Kappler J., Voges J., Koulousakis A., Lehrke R., Hefter H., Freund H. J. Bilateral high-frequency stimulation of the internal globus pallidus in advanced Parkinson's disease. Ann Neurol. 1998 Dec;44(6):953–961. doi: 10.1002/ana.410440615. [DOI] [PubMed] [Google Scholar]
  46. Wichmann T., DeLong M. R. Functional and pathophysiological models of the basal ganglia. Curr Opin Neurobiol. 1996 Dec;6(6):751–758. doi: 10.1016/s0959-4388(96)80024-9. [DOI] [PubMed] [Google Scholar]
  47. de Mari M., Margari L., Lamberti P., Iliceto G., Ferrari E. Changes in the amplitude of the N30 frontal component of SEPs during apomorphine test in parkinsonian patients. J Neural Transm Suppl. 1995;45:171–176. [PubMed] [Google Scholar]

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