Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation
M Merelloa b, S Starksteinb c, M I Nouzeillesa b, G Kuzisb, R Leiguardab
a Movement Disorders
Section, Raul Carrea Institute for Neurological Research (FLENI),
Montañeses 2325, 1428 Buenos Aires, Argentina, b Department of Neurology, c Department of
Neuropsychiatry
Correspondence to: Dr M Merello mmerello{at}fleni.orig.ar
Received 22 January 2001 and in revised form 18 June 2001;
Accepted 6 July 2001
OBJECTIVE
Posteroventral
pallidotomy (PVP) has proved to be an effective method for the
treatment of Parkinson's disease. However, data on bilateral
procedures are still limited. To assess the effects of bilateral globus
pallidus (GPi) lesion and to compare it with a combination of
unilateral GPi lesion plus contralateral GPi stimulation (PVP+PVS), an
open blind randomised trial was designed.
METHODSA prospective
series of patients with severe Parkinson's disease refractory to
medical treatment, and severe drug induced dyskinesias, were randomised
either to simultaneous bilateral PVP or simultaneous PVP+PVS. All
patients were assessed with the core assessment programme for
intracerebral transplantation (CAPIT), and a comprehensive
neuropsychological and neuropsychiatric battery both before surgery and
3 months later.
RESULTSThe severe
adverse effects found in the first three patients subjected to
bilateral PVP led to discontinuation of the protocol. All three
patients developed depression and apathy. Speech, salivation, and
swallowing, as well as freezing, walking, and falling, dramatically worsened. By contrast, all three patients undergoing PVP+PVS had a
significant motor improvement.
CONCLUSIONBilateral
simultaneous lesions within the GPi may produce severe motor and
psychiatric complications. On the other hand, a combination of PVP+ PVS
significantly improves parkinsonian symptoms not associated with the
side effects elicited by bilateral lesions.
Keywords: bilateral pallidotomy; deep brain stimulation; globus pallidus stimulation; psychic akinesia
© 2001 by Journal of Neurology, Neurosurgery, and Psychiatry
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