Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation
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...
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todo:paper_00223050_v71_n5_p611_Merello2023-10-03T14:30:56Z Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation Merello, M. Starkstein, S. Nouzeilles, M.I. Kuzis, G. Leiguarda, R. 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 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. JOUR info:eu-repo/semantics/openAccess http://creativecommons.org/licenses/by/2.5/ar http://hdl.handle.net/20.500.12110/paper_00223050_v71_n5_p611_Merello |
| institution |
Universidad de Buenos Aires |
| institution_str |
I-28 |
| repository_str |
R-134 |
| collection |
Biblioteca Digital - Facultad de Ciencias Exactas y Naturales (UBA) |
| topic |
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 |
| spellingShingle |
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 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 |
| topic_facet |
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 |
| description |
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. |
| format |
JOUR |
| author |
Merello, M. Starkstein, S. Nouzeilles, M.I. Kuzis, G. Leiguarda, R. |
| author_facet |
Merello, M. Starkstein, S. Nouzeilles, M.I. Kuzis, G. Leiguarda, R. |
| author_sort |
Merello, M. |
| title |
Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation |
| title_short |
Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation |
| title_full |
Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation |
| title_fullStr |
Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation |
| title_full_unstemmed |
Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation |
| title_sort |
bilateral pallidotomy for treatment of parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation |
| url |
http://hdl.handle.net/20.500.12110/paper_00223050_v71_n5_p611_Merello |
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