Effect of GPi pallidotomy on motor function in Parkinson's disease

doi:10.1016/S0140-6736(95)92404-3

The Lancet

Volume 346, Issue 8987, 25 November 1995, Pages 1383-1387

https://doi.org/10.1016/S0140-6736(95)92404-3 Get rights and content

Abstract

Summary

The major motor disturbances in Parkinson's disease are thought to be caused by overactivity of the internal segment of the globus pallidus (GPi), in large part due to excessive drive from the subthalamic nucleus. The excessive inhibitory activity of GPi is thought to "brake' the motor thalamus and the cortical motor system to produce the slowness, rigidity, and poverty of movement characteristic of parkinsonian states. To test the hypothesis that direct reduction of Gpi activity can improve motor function, we studied the effect of GPi pallidotomy in 14 patients. The location of the GPi nucleus was confirmed by microelectrode recording before lesion creation. Standardised videotape recordings before and after operation were randomised and scored by a "blinded' evaluator.

6 months after surgery, total motor score in the "off" state had improved by 30% and the total akinesia score by 33%. The gait score in the "off" state improved by 15% and a composite postural instability and gait score by 23%. After surgery there was almost total elimination of drug-induced involuntary movements (dyskinesias), with a 92% reduction on the side contralateral to the pallidotomy. No patient had visual or corticospinal complications. In these patients GPi pallidotomy enhanced motor performance, reduced akinesia, improved gait, and eliminated the neural elements responsible for levodopa-induced dyskinesias.

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Effect of GPi pallidotomy on motor function in Parkinson's disease

Abstract

TINS

TINS

Lancet

Lancet

Brain Res Rev

Neuroscience

Lancet

Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease

J Neurosurg

Open microsurgical autograft of adrenal medulla to the right caudate nucleus in two patients with intractable Parkinson's disease

N Eng J Med

Abnormal spontaneous activity of globus pallidus neurons in monkeys with MPTP-induced parkinsonism

Brain Res

Reversal of experimental parkinsonism by lesions in the subthalamic nucleus

Science

Reversal of rigidity and improvement of motor performance by subthalamic high-frequency stimulation in MPTP treated monkeys

Eur J Neurosci