Posteroventral medial pallidotomy in Parkinson's disease

Citation
Ae. Lang et al., Posteroventral medial pallidotomy in Parkinson's disease, J NEUROL, 246, 1999, pp. 28-41
Citations number
62
Categorie Soggetti
Neurosciences & Behavoir
Journal title
JOURNAL OF NEUROLOGY
ISSN journal
03405354 → ACNP
Volume
246
Year of publication
1999
Supplement
2
Pages
28 - 41
Database
ISI
SICI code
0340-5354(199909)246:<28:PMPIPD>2.0.ZU;2-R
Abstract
There has been a resurgence in the use of functional neurosurgery for Parki nson's disease. An important factor that has played a role in this developm ent is the recent understanding of the functional anatomy of the basal gang lia including a knowledge of the changes in the activities of neurons in th e internal segment of the globus pallidus (GPi) and the subthalamic nucleus (STN) in Parkinson's disease as well as the knowledge of the presence of s egregated functional loops within the basal ganglia which include a sensory -motor loop that involves the posteromedial globus pallidus rather than the anterior GPi where earlier pallidotomy lesions had been made. Laitinen rei ntroduced the modern posteroventral medial pallidotomy (PVMP) in 1992. Sinc e then it has become clear that this treatment has major effects on levodop a-induced dyskinesias and, unlike Vim thalamotomy, improves bradykinesia an d rigidity as well as tremor. In this report, we review a number of topics related to PVMP including the clinical results of pallidotomy available in the literature as well as an update of our own 2 year follow-up data, studi es evaluating factors that might predict the subsequent response to pallido tomy, the neuropsychological effects of the procedure, results of imaging s tudies including the correlation of clinical effects with lesion location, the question of bilateral pallidotomy and pallidotomy combined with deep br ain stimulation and finally whether PVMP is effective in other parkinsonian disorders.