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Pallidal stimulation for Parkinson's disease. Two targets?
B Bejjani1, P Damier, I Arnulf
1Centre d'Investigation Clinique-Fédération de Neurologie, Paris, France.
Neurology
|December 31, 1997
Summary
Deep brain stimulation in Parkinson's disease (PD) shows distinct effects based on globus pallidus (GP) location. Targeting dorsal GP improves motor symptoms, while posteroventral GP stimulation reduces dyskinesia but can worsen motor function.
Area of Science:
- Neuroscience
- Neurosurgery
- Movement Disorders
Background:
- Functional neurosurgery is gaining traction for Parkinson's disease (PD) treatment.
- Pallidotomy and pallidal stimulation effectively manage levodopa-induced dyskinesia (LID) and motor impairments, challenging existing basal ganglia models.
Purpose of the Study:
- To investigate the differential effects of deep brain stimulation (DBS) at distinct globus pallidus (GP) sites on PD motor symptoms and LID.
- To explore the functional organization within the GP for optimizing surgical targets in PD.
Main Methods:
- Deep brain stimulation was applied to different contacts within the globus pallidus (GP) in five Parkinson's disease (PD) patients.
- Effects on motor symptoms (gait, akinesia, rigidity) and levodopa-induced dyskinesia (LID) were assessed in both "on" and "off" levodopa states.
Main Results:
- Dorsal GP stimulation improved rigidity, akinesia, and gait, and could induce dyskinesia in the "off" state.
- Posteroventral GP stimulation worsened gait and akinesia but reduced rigidity. In the "on" state, it reduced LID but negated levodopa's motor benefits.
Conclusions:
- Stimulation at different GP loci yields distinct effects on parkinsonism and LID, suggesting separate anatomofunctional systems.
- The functional topography of the GP is critical for selecting optimal targets for surgical PD treatment.