Pallidal stimulation: an alternative to pallidotomy?

Full Abstract

A resurgence of interest in the surgical treatment of Parkinson's disease (PD) came with the rediscovery of posteroventral pallidotomy by Laitinen in 1985. Laitinen's procedure improved most symptoms in drug-resistant PD, which engendered wide interest in the neurosurgical community. Another lesioning procedure, ventrolateral thalamotomy, has become a powerful alternative to stimulate the nucleus ventralis intermedius, producing high long-term success rates and low morbidity rates. Pallidal stimulation has not met with the same success. According to the literature pallidotomy improves the "on" symptoms of PD, such as dyskinesias, as well as the "off" symptoms, such as rigidity, bradykinesia, and on-off fluctuations. Pallidal stimulation improves bradykinesia and rigidity to a minor extent; however, its strength seems to be in improving levodopa-induced dyskinesias. Stimulation often produces an improvement in the hyper- or dyskinetic upper limbs, but increases the "freezing" phenomenon in the lower limbs at the same time. Considering the small increase in the patient's independence, the high costs of bilateral implants, and the difficulty most patients experience in handling the devices, the question arises as to whether bilateral pallidal stimulation is a real alternative to pallidotomy.

Author information

Author/s: Tronnier, V M (VM); Fogel, W (W); Kronenbuerger, M (M); Steinvorth, S (S);

Affiliation: Department of Neurological Surgery, University Hospital, Heidelberg College of Medicine, Germany. vtronnier(-atsign-)krzmail.krz.uni-heidelberg.de

Journal and publication information

Publication Type: Journal Article

Journal: Journal of neurosurgery (J Neurosurg), published in UNITED STATES. (Language: eng)

Reference: 1997-Nov; vol 87 (issue 5) : pp 700-5

Dates: Created 1997/11/05; Completed 1997/11/05; Revised 2004/11/17;

PMID: 9347978, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: J Neurosurg. 1998 Aug;89(2):345-6. (PMID: 9688135)

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.