Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1997 Feb;62(2):125–132. doi: 10.1136/jnnp.62.2.125

Usefulness of pallidotomy in advanced Parkinson's disease.

F Johansson 1, J Malm 1, E Nordh 1, M Hariz 1
PMCID: PMC486722  PMID: 9048711

Abstract

OBJECTIVE: The combined effect of posteroventral pallidotomy and optimal medical treatment was assessed in 22 patients with levodopa sensitive Parkinson's disease. METHODS: Timed motor tests, video recordings, and computer assisted optoelectronic movement analysis were used for serial hourly assessments performed preoperatively and four and 12 months after operation. Tests were made while patients were on optimal medical therapy. RESULTS: There were no serious adverse events of surgery. Two of the 22 patients could not complete all the tests after operation. The proportion of dyskinesia periods decreased in the 20 patients and there was a proportional increase in normal or fairly normal occasions. "Off" periods were not significantly affected. In 12 of 13 patients with limb dyskinesia this symptom was completely abolished in the contralateral limbs. There was also some degree of improvement axially and ipsilaterally. Tremor was moderately improved contralaterally. Bradykinesia remained unchanged. Results at 12 months follow up were similar to those at four months. CONCLUSION: Pallidotomy produced a pronounced positive effect on dyskinesia and a moderate effect on tremor. Bradykinesia was not affected. Posteroventral pallidotomy may be useful in patients with Parkinson's disease who have severe motor fluctuations and may allow an increase in levodopa dose to alleviate bradykinesia in "off" states.

Full text

PDF
125

Images in this article

128Image
on p.128
129Image
on p.129

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bakay R. A., DeLong M. R., Vitek J. L. Posteroventral pallidotomy for Parkinson's disease. J Neurosurg. 1992 Sep;77(3):487–488. doi: 10.3171/jns.1992.77.3.0487. [DOI] [PubMed] [Google Scholar]
  2. Benabid A. L., Pollak P., Louveau A., Henry S., de Rougemont J. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987;50(1-6):344–346. doi: 10.1159/000100803. [DOI] [PubMed] [Google Scholar]
  3. Benabid A. L., Pollak P., Seigneuret E., Hoffmann D., Gay E., Perret J. Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias. Acta Neurochir Suppl (Wien) 1993;58:39–44. doi: 10.1007/978-3-7091-9297-9_8. [DOI] [PubMed] [Google Scholar]
  4. Blond S., Caparros-Lefebvre D., Parker F., Assaker R., Petit H., Guieu J. D., Christiaens J. L. Control of tremor and involuntary movement disorders by chronic stereotactic stimulation of the ventral intermediate thalamic nucleus. J Neurosurg. 1992 Jul;77(1):62–68. doi: 10.3171/jns.1992.77.1.0062. [DOI] [PubMed] [Google Scholar]
  5. Calne D. B., Snow B. J., Lee C. Criteria for diagnosing Parkinson's disease. Ann Neurol. 1992;32 (Suppl):S125–S127. doi: 10.1002/ana.410320721. [DOI] [PubMed] [Google Scholar]
  6. Caparros-Lefebvre D., Blond S., Vermersch P., Pécheux N., Guieu J. D., Petit H. Chronic thalamic stimulation improves tremor and levodopa induced dyskinesias in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1993 Mar;56(3):268–273. doi: 10.1136/jnnp.56.3.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Diederich N., Goetz C. G., Stebbins G. T., Klawans H. L., Nittner K., Koulosakis A., Sanker P., Sturm V. Blinded evaluation confirms long-term asymmetric effect of unilateral thalamotomy or subthalamotomy on tremor in Parkinson's disease. Neurology. 1992 Jul;42(7):1311–1314. doi: 10.1212/wnl.42.7.1311. [DOI] [PubMed] [Google Scholar]
  8. Dogali M., Fazzini E., Kolodny E., Eidelberg D., Sterio D., Devinsky O., Berić A. Stereotactic ventral pallidotomy for Parkinson's disease. Neurology. 1995 Apr;45(4):753–761. doi: 10.1212/wnl.45.4.753. [DOI] [PubMed] [Google Scholar]
  9. Eisen A. A., Shtybel W. AAEM minimonograph #35: Clinical experience with transcranial magnetic stimulation. Muscle Nerve. 1990 Nov;13(11):995–1011. doi: 10.1002/mus.880131102. [DOI] [PubMed] [Google Scholar]
  10. Fahn S. Fetal-tissue transplants in Parkinson's disease. N Engl J Med. 1992 Nov 26;327(22):1589–1590. doi: 10.1056/NEJM199211263272209. [DOI] [PubMed] [Google Scholar]
  11. Goetz C. G., De Long M. R., Penn R. D., Bakay R. A. Neurosurgical horizons in Parkinson's disease. Neurology. 1993 Jan;43(1):1–7. doi: 10.1212/wnl.43.1_part_1.1. [DOI] [PubMed] [Google Scholar]
  12. Iacono R. P., Lonser R. R., Mandybur G., Morenski J. D., Yamada S., Shima F. Stereotactic pallidotomy results for Parkinson's exceed those of fetal graft. Am Surg. 1994 Oct;60(10):777–782. [PubMed] [Google Scholar]
  13. Iacono R. P., Lonser R. R. Reversal of Parkinson's akinesia by pallidotomy. Lancet. 1994 Feb 12;343(8894):418–419. doi: 10.1016/s0140-6736(94)91255-6. [DOI] [PubMed] [Google Scholar]
  14. Iacono R. P., Shima F., Lonser R. R., Kuniyoshi S., Maeda G., Yamada S. The results, indications, and physiology of posteroventral pallidotomy for patients with Parkinson's disease. Neurosurgery. 1995 Jun;36(6):1118–1127. doi: 10.1227/00006123-199506000-00008. [DOI] [PubMed] [Google Scholar]
  15. Johnels B., Ingvarsson P. E., Holmberg B., Matousek M., Steg G. Single-dose L-dopa response in early Parkinson's disease: measurements with optoelectronic recording technique. Mov Disord. 1993;8(1):56–62. doi: 10.1002/mds.870080111. [DOI] [PubMed] [Google Scholar]
  16. Johnels B., Ingvarsson P. E., Matousek M., Steg G., Heinonen E. H. Optoelectronic movement analysis in Parkinson's disease: effect of selegiline on the disability in de novo parkinsonian patients--a pilot study. Acta Neurol Scand Suppl. 1991;136:40–43. doi: 10.1111/j.1600-0404.1991.tb05019.x. [DOI] [PubMed] [Google Scholar]
  17. Johnels B., Ingvarsson P. E., Thorselius M., Valls M., Steg G. Disability profiles and objective quantitative assessment in Parkinson's disease. Acta Neurol Scand. 1989 Mar;79(3):227–238. doi: 10.1111/j.1600-0404.1989.tb03743.x. [DOI] [PubMed] [Google Scholar]
  18. Joyce C. R., Zutshi D. W., Hrubes V., Mason R. M. Comparison of fixed interval and visual analogue scales for rating chronic pain. Eur J Clin Pharmacol. 1975 Aug 14;8(6):415–420. doi: 10.1007/BF00562315. [DOI] [PubMed] [Google Scholar]
  19. Kelly P. J. Pallidotomy in Parkinson's disease. Neurosurgery. 1995 Jun;36(6):1154–1157. doi: 10.1227/00006123-199506000-00014. [DOI] [PubMed] [Google Scholar]
  20. Klockgether T., Löschmann P. A., Wüllner U. New medical and surgical treatments for Parkinson's disease. Curr Opin Neurol. 1994 Aug;7(4):346–352. doi: 10.1097/00019052-199408000-00012. [DOI] [PubMed] [Google Scholar]
  21. Kokmen E., Naessens J. M., Offord K. P. A short test of mental status: description and preliminary results. Mayo Clin Proc. 1987 Apr;62(4):281–288. doi: 10.1016/s0025-6196(12)61905-3. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. Laitinen L. V., Bergenheim A. T., Hariz M. I. Ventroposterolateral pallidotomy can abolish all parkinsonian symptoms. Stereotact Funct Neurosurg. 1992;58(1-4):14–21. doi: 10.1159/000098965. [DOI] [PubMed] [Google Scholar]
  24. Laitinen L. V. Pallidotomy for Parkinson's disease. Neurosurg Clin N Am. 1995 Jan;6(1):105–112. [PubMed] [Google Scholar]
  25. Laitinen L. V. Ventroposterolateral pallidotomy. Stereotact Funct Neurosurg. 1994;62(1-4):41–52. doi: 10.1159/000098596. [DOI] [PubMed] [Google Scholar]
  26. Lindvall O., Widner H., Rehncrona S., Brundin P., Odin P., Gustavii B., Frackowiak R., Leenders K. L., Sawle G., Rothwell J. C. Transplantation of fetal dopamine neurons in Parkinson's disease: one-year clinical and neurophysiological observations in two patients with putaminal implants. Ann Neurol. 1992 Feb;31(2):155–165. doi: 10.1002/ana.410310206. [DOI] [PubMed] [Google Scholar]
  27. Lozano A. M., Lang A. E., Galvez-Jimenez N., Miyasaki J., Duff J., Hutchinson W. D., Dostrovsky J. O. Effect of GPi pallidotomy on motor function in Parkinson's disease. Lancet. 1995 Nov 25;346(8987):1383–1387. doi: 10.1016/s0140-6736(95)92404-3. [DOI] [PubMed] [Google Scholar]
  28. Marsden C. D. Parkinson's disease. J Neurol Neurosurg Psychiatry. 1994 Jun;57(6):672–681. doi: 10.1136/jnnp.57.6.672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Miles J., Redfern R. M. The place of thalamotomy in the treatment of parkinsonism. Br J Neurosurg. 1987;1(3):311–315. doi: 10.3109/02688698709023772. [DOI] [PubMed] [Google Scholar]
  30. Olanow C. W., Marsden C. D., Lang A. E., Goetz C. G. The role of surgery in Parkinson's disease management. Neurology. 1994 Mar;44(3 Suppl 1):S17–S20. [PubMed] [Google Scholar]
  31. Quinn N. Reversal of Parkinson's akinesia by pallidotomy. Lancet. 1994 Apr 30;343(8905):1095–1096. doi: 10.1016/s0140-6736(94)90204-6. [DOI] [PubMed] [Google Scholar]
  32. SVENNILSON E., TORVIK A., LOWE R., LEKSELL L. Treatment of parkinsonism by stereotatic thermolesions in the pallidal region. A clinical evaluation of 81 cases. Acta Psychiatr Scand. 1960;35:358–377. doi: 10.1111/j.1600-0447.1960.tb07606.x. [DOI] [PubMed] [Google Scholar]
  33. Skovlund E., Flaten O. Response measures in the acute treatment of migraine. Cephalalgia. 1995 Dec;15(6):519-22, discussion 450-1. doi: 10.1046/j.1468-2982.1995.1506519.x. [DOI] [PubMed] [Google Scholar]
  34. Sutton J. P., Couldwell W., Lew M. F., Mallory L., Grafton S., DeGiorgio C., Welsh M., Apuzzo M. L., Ahmadi J., Waters C. H. Ventroposterior medial pallidotomy in patients with advanced Parkinson's disease. Neurosurgery. 1995 Jun;36(6):1112–1117. doi: 10.1227/00006123-199506000-00007. [DOI] [PubMed] [Google Scholar]
  35. Tasker R. R. Tremor of parkinsonism and stereotactic thalamotomy. Mayo Clin Proc. 1987 Aug;62(8):736–739. doi: 10.1016/s0025-6196(12)65227-6. [DOI] [PubMed] [Google Scholar]
  36. Widner H., Rehncrona S. Transplantation and surgical treatment of parkinsonian syndromes. Curr Opin Neurol Neurosurg. 1993 Jun;6(3):344–349. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES