Background Human intrastriatal fetal allografts survive over long periods of time in the brains of Parkinson's disease (PD) patients and integrate into host circuitry. However, some grafted patients with a prior history of levodopa-induced dyskinesias have developed off-medication dyskinesias and dystonias following allografting whose mechanism remains poorly understood. The authors present single-unit discharge characteristics in the external and internal globus pallidus (GPe and GPi) in an awake patient with PD undergoing microelectrode-guided surgery for pallidal deep brain stimulation, 10 years following bilateral intraputamenal fetal mesencephalic allografting in an NIH-funded protocol.
Methods Pallidal single-unit activity at ‘rest’ and during active movement was evaluated and compared with data sets from 13 PD patients in the ‘off-medication’ state and from one non-dyskinetic PD patient in the ‘on-medication’ state.
Results and discussion Analysis of firing rate, bursting discharge and oscillatory activity showed that the graft corrected some, but not all, of the abnormalities associated with the off-medication state. Additionally, in the transplanted patient, voluntary hand movement produced a marked reduction in pallidal discharge rate at multiple GPi recording sites, which was not observed during active movement in other patients. These findings are consistent with a persistent effect of transplanted dopamine cells on basal ganglia outflow and suggest a mechanism for the graft-induced dystonic phenotype.
- Electrical stimulation
- movement disorders
- Parkinson's disease
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Competing interests None.
Ethics approval Ethics approval was provided by the University of California, San Francisco Committee on Human Research.
Provenance and peer review Not commissioned; externally peer reviewed.