Pallidal activity during dystonia: somatosensory reorganisation and changes with severity
- F A Lenza,
- J I Suarezb,
- L Verhagen Metmanc,
- S G Reichb,
- B I Karpd,
- M Hallettd,
- L H Rowlanda,
- P M Doughertya
- aDepartment of Neurosurgery, bDepartment of Neurology, Johns Hopkins University, Baltimore, MD, USA, cExperimental Therapeutics Branch, dHuman Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Dr FA Lenz, Department of Neurosurgery, Meyer Building 7–113, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287–7713, USA. Telephone 001 410 955 2257; fax 001 410 614 9877.
- Received 15 December 1998
- Revised 6 April 1998
- Accepted 13 May 1998
Abstract
A woman with progressive, medically intractable right upper limb dystonia underwent a pallidotomy with only transient improvement. During the procedure her dystonia became more severe as she repeatedly made a fist to command in order to provoke dystonia transiently (movement provoked dystonia). Comparisons within cells in the internal segment of the globus pallidus (Gpi) disclosed that the firing rate was the same at rest, with making a fist, and during movement provoked dystonia. However, the firing rate compared between cells decreased significantly throughout the procedure as the patient made a fist repeatedly. During the second half of the procedure the firing rate of cells in the Gpi was similar to that in hemiballismus. The proportion of cells in the GPi which responded to sensory stimulation was significantly higher in dystonia (53%) than in hemiballismus (13%). These results suggest that pallidal activity can correlate inversely with the severity of dystonia, perhaps due to activity dependent changes in neuronal function resulting from repeated voluntary movement.
