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August 1997, Vol 54, No. 8 >
Article | August 1997

Posteroventral Medial Pallidotomy in Levodopa-Unresponsive Parkinsonism

Joachim K. Krauss, MD; Joseph Jankovic, MD; Eugene C. Lai, MD, PhD; Gayle M. Rettig, PhD; Robert G. Grossman, MD
Arch Neurol. 1997;54(8):1026-1029. doi:10.1001/archneur.1997.00550200082014
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Background:  Parkinsonism in a 42-year-old patient, which was presumably related to peripheral trauma, did not respond to levodopa therapy.

Observation:  We treated the patient with microelectrode-guided unilateral posteroventral medial pallidotomy and followed up with magnetic resonance imaging and prospective clinical evaluation. Pallidotomy resulted in marked improvement of right-sided parkinsonian symptoms and functional disability at 4.5 months after surgery. Microelectrode recording during pallidotomy revealed discharge patterns that were similar to those seen in patients with Parkinson disease. Postoperative magnetic resonance imaging confirmed the location of the lesion in the posteroventral medial pallidum.

Conclusions:  Posteroventral pallidotomy usually has limited benefit in patients with degenerative atypical parkinsonism who do not respond to levodopa therapy. Nevertheless, pallidotomy can be an effective treatment for other levodopa-unresponsive parkinsonian disorders.

REFERENCES

1 +
Laitinen LV, Bergenheim AT, Hariz Ml.  Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease . J Neurosurg . 1992;;76:53-61.
2 +
Iacono RP, Shima F, Lonser RR, Kuniyoshi S, Maeda G, Yamada S.  The results, indications, and physiology of posteroventral pallidotomy for patients with Parkinson's disease . Neurosurgery . 1995;;36:1118-1127.
3 +
Dogali M, Fazzini E, Kolodny E, et al.  Stereotactic ventral pallidotomy for Parkinson's disease . Neurology . 1995;;45:753-761.
4 +
Lozano AM, Lang AE, Galvez-Jimenez N, et al.  Effect of GPi pallidotomy on motor function in Parkinson's disease . Lancet . 1995;;346:1383-1387.
5 +
Baron MS, Vitek JL, Bakay RAE, et al.  Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study . Ann Neurol . 1996;;40:355-366.
6 +
Favre J, Taha JM, Nguyen TT, Gildenberg PL, Burchiel KJ.  Pallidotomy: a survey of current practice in North America . Neurosurgery . 1996;;39:883-892.
7 +
Kelly PJ.  Pallidotomy in Parkinson's disease . Neurosurgery . 1995;;36:1154-1157.
8 +
Olanow CW.  GPi pallidotomy: have we made a dent in Parkinson's disease? Ann Neurol . 1996;;40:341-343.
9 +
Alterman R, Kelly P, Beric A, et al.  Selection criteria for posteroventral pallidotomy . Acta Neurochir . 1996;;138:636. Abstract.
10 +
Fazzini E, Dogali M, Beric A, et al.  Ventral pallidotomy operations in patients with Parkinson's plus syndromes: lack of significant symptomatic benefit . Ann Neurol . 1993;;34:266. Abstract.
11 +
Laitinen LV.  Pallidotomy for Parkinson's disease . Neurosurg Clin North Am . 1995;; 6:105-112.
12 +
Miyasaki JM, Lozano A, Duff J, Dostrovsky J, St Cyr J, Lang AE.  The role of posteroventral pallidotomy in advanced Parkinson's disease (PD) and striatonigral degeneration (SND) . Neurology . 1994;;44( (suppl 2) ):322-323. Abstract.
13 +
Bosch A, Schuurman R, Speelman H.  Posteroventral pallidotomy in movement disorders . Acta Neurochir . 1996;;138:635-636. Abstract.
14 +
Cardoso F, Jankovic J.  Peripherally induced tremor and parkinsonism . Arch Neurol . 1995;;52:263-270.
15 +
Langston JW, Widner H, Goetz CG, et al.  Core Assessment Program for Intracerebral Transplantations (CAPIT) . Mov Disord . 1992;;7:2-13.
16 +
Krauss JK, Akeyson EW, Giam P, Jankovic J.  Propofol-induced dyskinesias in Parkinson's disease . Anesth Analg . 1996;;83:420-422.
17 +
Krauss JK, Grossman RG. Surgical treatment of movement disorders. In: Grossman RG, Loftus CM, eds. Principles of Neurosurgery. Philadelphia, Pa: JB Lippincott. In press.
18 +
Krauss JK, Desaloms JM, Lai EC, King DE, Jankovic J, Grossman RG. Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's disease: postoperative magnetic resonance imaging analysis. J Neurosurg. In press.
19 +
Hutchison WD, Lozano AM, Davis KD, Saint-Cyr JA, Lang AE, Dostrovsky JO.  Differential neuronal activity in segments of globus pallidus in Parkinson's disease patients . Neuroreport . 1994;;5:1533-1537.
20 +
Sterio D, Beric A, Dogali M, Fazzini E, Alfaro G, Devinsky O.  Neurophysiological properties of pallidal neurons in Parkinson's disease . Ann Neurol . 1994;;35:586-591.
21 +
Lozano A, Hutchison W, Kiss Z, Tasker R, Davis K, Dostrovsky J.  Methods for microelectrode-guided posteroventral pallidotomy . J Neurosurg . 1996;;84:194-202.
22 +
Jankovic J.  Treatment of parkinsonian syndromes . In: Kurlan R, ed. Treatment of Movement Disorders . Philadelphia, Pa: JB Lippincott; 1995;:95-114.
23 +
Koller WC, Wong GF, Lang A.  Posttraumatic movement disorders: a review . Mov Disord . 1989;;4:20-36.
24 +
Goetz CG, Pappert EJ.  Trauma and movement disorders . Neurol Clin . 1992;;10:907-919.
25 +
Jankovic J.  Post-traumatic movement disorders: central and peripheral mechanisms . Neurology . 1994;;44:2006-2014.
26 +
Curran TG, Lang AE.  Trauma and tremor . In: Findley LJ, Koller WC, eds. Parkinsonian Syndromes . New York, NY: Marcel Dekker Inc; 1995;:411-428.
27 +
Factor SA.  Posttraumatic parkinsonism . In: Stern MB, Koller WC, eds. Parkinsonian Syndromes . New York, NY: Marcel Dekker Inc; 1993;:95-110.
28 +
Krauss JK, Tränkle R, Kopp KH.  Posttraumatic movement disorders in survivors of severe head injury . Neurology . 1996;;47:1488-1492.
29 +
Morsier de G.  Parkinsonisme consécutife à une lésion traumatique du nojau rouge et du locus niger . Psychiatry Neurol . 1960;;139:60-64.
30 +
Albin RL.  The pathophysiology of chorea/ballism and parkinsonism . Park Rel Disord . 1995;;1:3-11.
31 +
Brotchie JM, Mitchell IJ, Sambrook MA, Crossman AR.  Alleviation of parkinsonism by antagonism of excitatory amino acid transmission in the medial segment of the globus pallidus in rat and primate . Mov Disord . 1991;;6:133-138.
32 +
De Long MR.  Primate models of movement disorders of basal ganglia origin . Trends Neurosci . 1990;;13:281-285.
33 +
De Long MR, Crutcher MD, Georgopoulos AP.  Primate globus pallidus and subthalamic nucleus: functional organization . J Neurophysiol . 1985;;53:530-543.

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1 +
Laitinen LV, Bergenheim AT, Hariz Ml.  Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease . J Neurosurg . 1992;;76:53-61.
2 +
Iacono RP, Shima F, Lonser RR, Kuniyoshi S, Maeda G, Yamada S.  The results, indications, and physiology of posteroventral pallidotomy for patients with Parkinson's disease . Neurosurgery . 1995;;36:1118-1127.
3 +
Dogali M, Fazzini E, Kolodny E, et al.  Stereotactic ventral pallidotomy for Parkinson's disease . Neurology . 1995;;45:753-761.
4 +
Lozano AM, Lang AE, Galvez-Jimenez N, et al.  Effect of GPi pallidotomy on motor function in Parkinson's disease . Lancet . 1995;;346:1383-1387.
5 +
Baron MS, Vitek JL, Bakay RAE, et al.  Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study . Ann Neurol . 1996;;40:355-366.
6 +
Favre J, Taha JM, Nguyen TT, Gildenberg PL, Burchiel KJ.  Pallidotomy: a survey of current practice in North America . Neurosurgery . 1996;;39:883-892.
7 +
Kelly PJ.  Pallidotomy in Parkinson's disease . Neurosurgery . 1995;;36:1154-1157.
8 +
Olanow CW.  GPi pallidotomy: have we made a dent in Parkinson's disease? Ann Neurol . 1996;;40:341-343.
9 +
Alterman R, Kelly P, Beric A, et al.  Selection criteria for posteroventral pallidotomy . Acta Neurochir . 1996;;138:636. Abstract.
10 +
Fazzini E, Dogali M, Beric A, et al.  Ventral pallidotomy operations in patients with Parkinson's plus syndromes: lack of significant symptomatic benefit . Ann Neurol . 1993;;34:266. Abstract.
11 +
Laitinen LV.  Pallidotomy for Parkinson's disease . Neurosurg Clin North Am . 1995;; 6:105-112.
12 +
Miyasaki JM, Lozano A, Duff J, Dostrovsky J, St Cyr J, Lang AE.  The role of posteroventral pallidotomy in advanced Parkinson's disease (PD) and striatonigral degeneration (SND) . Neurology . 1994;;44( (suppl 2) ):322-323. Abstract.
13 +
Bosch A, Schuurman R, Speelman H.  Posteroventral pallidotomy in movement disorders . Acta Neurochir . 1996;;138:635-636. Abstract.
14 +
Cardoso F, Jankovic J.  Peripherally induced tremor and parkinsonism . Arch Neurol . 1995;;52:263-270.
15 +
Langston JW, Widner H, Goetz CG, et al.  Core Assessment Program for Intracerebral Transplantations (CAPIT) . Mov Disord . 1992;;7:2-13.
16 +
Krauss JK, Akeyson EW, Giam P, Jankovic J.  Propofol-induced dyskinesias in Parkinson's disease . Anesth Analg . 1996;;83:420-422.
17 +
Krauss JK, Grossman RG. Surgical treatment of movement disorders. In: Grossman RG, Loftus CM, eds. Principles of Neurosurgery. Philadelphia, Pa: JB Lippincott. In press.
18 +
Krauss JK, Desaloms JM, Lai EC, King DE, Jankovic J, Grossman RG. Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's disease: postoperative magnetic resonance imaging analysis. J Neurosurg. In press.
19 +
Hutchison WD, Lozano AM, Davis KD, Saint-Cyr JA, Lang AE, Dostrovsky JO.  Differential neuronal activity in segments of globus pallidus in Parkinson's disease patients . Neuroreport . 1994;;5:1533-1537.
20 +
Sterio D, Beric A, Dogali M, Fazzini E, Alfaro G, Devinsky O.  Neurophysiological properties of pallidal neurons in Parkinson's disease . Ann Neurol . 1994;;35:586-591.
21 +
Lozano A, Hutchison W, Kiss Z, Tasker R, Davis K, Dostrovsky J.  Methods for microelectrode-guided posteroventral pallidotomy . J Neurosurg . 1996;;84:194-202.
22 +
Jankovic J.  Treatment of parkinsonian syndromes . In: Kurlan R, ed. Treatment of Movement Disorders . Philadelphia, Pa: JB Lippincott; 1995;:95-114.
23 +
Koller WC, Wong GF, Lang A.  Posttraumatic movement disorders: a review . Mov Disord . 1989;;4:20-36.
24 +
Goetz CG, Pappert EJ.  Trauma and movement disorders . Neurol Clin . 1992;;10:907-919.
25 +
Jankovic J.  Post-traumatic movement disorders: central and peripheral mechanisms . Neurology . 1994;;44:2006-2014.
26 +
Curran TG, Lang AE.  Trauma and tremor . In: Findley LJ, Koller WC, eds. Parkinsonian Syndromes . New York, NY: Marcel Dekker Inc; 1995;:411-428.
27 +
Factor SA.  Posttraumatic parkinsonism . In: Stern MB, Koller WC, eds. Parkinsonian Syndromes . New York, NY: Marcel Dekker Inc; 1993;:95-110.
28 +
Krauss JK, Tränkle R, Kopp KH.  Posttraumatic movement disorders in survivors of severe head injury . Neurology . 1996;;47:1488-1492.
29 +
Morsier de G.  Parkinsonisme consécutife à une lésion traumatique du nojau rouge et du locus niger . Psychiatry Neurol . 1960;;139:60-64.
30 +
Albin RL.  The pathophysiology of chorea/ballism and parkinsonism . Park Rel Disord . 1995;;1:3-11.
31 +
Brotchie JM, Mitchell IJ, Sambrook MA, Crossman AR.  Alleviation of parkinsonism by antagonism of excitatory amino acid transmission in the medial segment of the globus pallidus in rat and primate . Mov Disord . 1991;;6:133-138.
32 +
De Long MR.  Primate models of movement disorders of basal ganglia origin . Trends Neurosci . 1990;;13:281-285.
33 +
De Long MR, Crutcher MD, Georgopoulos AP.  Primate globus pallidus and subthalamic nucleus: functional organization . J Neurophysiol . 1985;;53:530-543.

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