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Abstract:

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. Methods - A 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. Results - The 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. Conclusion - Bilateral 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.

Registro:

Documento: Artículo
Título:Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation
Autor:Merello, M.; Starkstein, S.; Nouzeilles, M.I.; Kuzis, G.; Leiguarda, R.
Filiación:Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428 Buenos Aires, Argentina
Department of Neurology, Montañeses 2325, 1428 Buenos Aires, Argentina
Department of Neuropsychiatry, Montañeses 2325, 1428 Buenos Aires, Argentina
Palabras clave:Bilateral pallidotomy; Deep brain stimulation; Globus pallidus stimulation; Psychic akinesia; antiparkinson agent; adult; aged; akinesia; apathy; article; brain depth stimulation; clinical article; clinical trial; controlled clinical trial; controlled study; depression; dyskinesia; female; globus pallidus; human; male; motor dysfunction; motor performance; pallidotomy; Parkinson disease; priority journal; prospective study; psychologic assessment; randomized controlled trial; speech disorder; syndrome; Aged; Deglutition Disorders; Depressive Disorder; Double-Blind Method; Electric Stimulation Therapy; Female; Functional Laterality; Globus Pallidus; Humans; Male; Neurosurgical Procedures; Parkinson Disease; Prospective Studies; Pyramidal Tracts; Speech Disorders; Syndrome
Año:2001
Volumen:71
Número:5
Página de inicio:611
Página de fin:614
DOI: http://dx.doi.org/10.1136/jnnp.71.5.611
Título revista:Journal of Neurology Neurosurgery and Psychiatry
Título revista abreviado:J. Neurol. Neurosurg. Psychiatry
ISSN:00223050
CODEN:JNNPA
Registro:https://bibliotecadigital.exactas.uba.ar/collection/paper/document/paper_00223050_v71_n5_p611_Merello

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Citas:

---------- APA ----------
Merello, M., Starkstein, S., Nouzeilles, M.I., Kuzis, G. & Leiguarda, R. (2001) . Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation. Journal of Neurology Neurosurgery and Psychiatry, 71(5), 611-614.
http://dx.doi.org/10.1136/jnnp.71.5.611
---------- CHICAGO ----------
Merello, M., Starkstein, S., Nouzeilles, M.I., Kuzis, G., Leiguarda, R. "Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation" . Journal of Neurology Neurosurgery and Psychiatry 71, no. 5 (2001) : 611-614.
http://dx.doi.org/10.1136/jnnp.71.5.611
---------- MLA ----------
Merello, M., Starkstein, S., Nouzeilles, M.I., Kuzis, G., Leiguarda, R. "Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation" . Journal of Neurology Neurosurgery and Psychiatry, vol. 71, no. 5, 2001, pp. 611-614.
http://dx.doi.org/10.1136/jnnp.71.5.611
---------- VANCOUVER ----------
Merello, M., Starkstein, S., Nouzeilles, M.I., Kuzis, G., Leiguarda, R. Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation. J. Neurol. Neurosurg. Psychiatry. 2001;71(5):611-614.
http://dx.doi.org/10.1136/jnnp.71.5.611