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J D Speelman - One of the best experts on this subject based on the ideXlab platform.
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long term superiority of subthalamic nucleus stimulation over Pallidotomy in parkinson disease
Neurology, 2009Co-Authors: R. M. A. De Bie, R. A.j. Esselink, Peter C. G. Nijssen, R J De Haan, Mathieu W P M Lenders, Van Teus Laar, P R Schuurman, Dirk Bosch, J D SpeelmanAbstract:The results of our multicenter randomized controlled trial comparing unilateral Pallidotomy with bilateral subthalamic nucleus (STN) stimulation in advanced Parkinson disease (PD) demonstrated that STN stimulation is more effective than Pallidotomy up to 1 year postoperatively.1,2 Here we present the 4-year follow-up of this trial. ### Methods. Thirty-four patients with advanced PD were randomly assigned to have unilateral Pallidotomy or bilateral STN stimulation. Inclusion and exclusion criteria and study methods were described previously.1,2 The 2 assessors were blinded to the treatment allocation during the complete follow-up. For patients allocated to unilateral Pallidotomy, the protocol allowed STN stimulation at least 6 months after Pallidotomy. Outcome measures were the off and on phase motor Unified Parkinson's Disease Rating Scale (UPDRS) scores,3 dyskinesia severity (Clinical Dyskinesias Rating Scale),4 functional status (activities of daily living [ADL] UPDRS),3 PD Quality of Life questionnaire,5 levodopa equivalent dose,2 and adverse events. Difference in median change scores (4 years follow-up minus baseline) between treatment groups were analyzed using the Mann-Whitney U test or Kruskal-Wallis rank test, when …
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Unilateral Pallidotomy versus bilateral subthalamic nucleus stimulation in Parkinson’s disease: one year follow-up of a randomised observer-blind multi centre trial
Acta Neurochirurgica, 2006Co-Authors: R. A.j. Esselink, R. M. A. De Bie, R J De Haan, P R Schuurman, D A Bosch, E. N. H. J. Steur, G. N. Beute, A. T. Portman, J D SpeelmanAbstract:Background . To investigate whether STN stimulation is more efficacious than unilateral Pallidotomy in advanced Parkinson’s disease (PD) one year after surgery. Method . Thirty-four patients with advanced PD were randomly assigned to unilateral Pallidotomy or bilateral STN stimulation. Outcome measures were parkinsonian symptoms in off and on phases (UPDRS 3), dyskinesias, functional status, Parkinson’s disease quality of life questionnaire, the effects on separate symptoms, timed tests, patient diaries, dopaminergic drugs changes, adverse effects, and global outcome scale. Patients were assessed before surgery, six months and one year after surgery. The primary outcome measure was the off phase UPDRS 3 at six months follow-up. Findings . The off phase UPDRS 3 score improved from 46.5 to 32 points in the Pallidotomy patients and from 51.5 to 24 in the STN stimulation patients ( p = 0.002). On phase UPDRS 3 and off phase Schwab and England functional scale improved significantly in favour of the STN stimulation patients. Dopaminergic drugs reduction was larger in the STN group although the difference between the treatment groups was not significant. One patient in each group had a major adverse effect. Conclusions . Bilateral STN stimulation is more efficacious than unilateral Pallidotomy in advanced PD up to one year after surgery.
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unilateral Pallidotomy versus bilateral subthalamic nucleus stimulation in pd a comparison of neuropsychological effects
Journal of Neurology, 2005Co-Authors: Harriet M M Smeding, Ben Schmand, Rianne A J Esselink, Marthe Koninghaanstra, Ilse Nijhuis, Elze M Wijnalda, J D SpeelmanAbstract:OBJECTIVE: To compare the cognitive and behavioural effects of unilateral Pallidotomy and bilateral subthalamic nucleus (STN) stimulation. METHODS: After baseline examination 34 patients were randomly assigned to unilateral Pallidotomy (4 left-sided, 10 right-sided) or bilateral STN stimulation (n = 20). At baseline and six and twelve months after surgery we administered neuropsychological tests of language, memory, visuospatial function, mental speed and executive functions. Also a depression rating scale, and self and proxy ratings of memory and dysexecutive symptoms were administered. RESULTS: Six months after surgery, the STN group and the Pallidotomy group differed significantly in change from baseline in number of errors on two tests of executive functioning. After 12 months the STN group reported less positive affect compared with baseline than the Pallidotomy group. One patient in the STN group showed an overall cognitive deterioration due to complications. CONCLUSIONS: Although we need larger groups to draw firm conclusions, our results suggest that bilateral STN stimulation has slightly more negative effects on executive functioning than unilateral Pallidotomy.
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unilateral Pallidotomy versus bilateral subthalamic nucleus stimulation in pd a randomized trial
Neurology, 2004Co-Authors: R. A.j. Esselink, R. M. A. De Bie, Peter C. G. Nijssen, Michiel J. Staal, Harriet M M Smeding, R J De Haan, Mathieu W P M Lenders, P R Schuurman, D A Bosch, J D SpeelmanAbstract:Objective: To compare the efficacy of unilateral Pallidotomy and bilateral subthalamic nucleus (STN) stimulation in patients with advanced Parkinson disease (PD) in a randomized, observer-blind, multicenter trial. Methods: Thirty-four patients with advanced PD were randomly assigned to have unilateral Pallidotomy or bilateral STN stimulation. The primary outcome was the change from baseline to 6 months in the motor part of the Unified PD Rating Scale (motor UPDRS) in the off phase. Secondary outcomes were parkinsonian symptoms in the on phase (motor UPDRS), dyskinesias (Clinical Dyskinesia Rating Scale and dyskinesias UPDRS), functional status (activities of daily living UPDRS and Schwab and England scale), PD Quality of Life questionnaire, changes in drug treatment, and adverse effects. Results: The off phase motor UPDRS score improved from 46.5 to 37 points in the group of Pallidotomy patients and from 51.5 to 26.5 in the STN stimulation patients ( p = 0.002). Of the secondary outcome measures, on phase motor UPDRS and dyskinesias UPDRS improved significantly in favor of the STN stimulation patients. Reduction of antiparkinsonian drugs was greater after STN stimulation than after Pallidotomy. One patient in each group had a major adverse effect. Conclusions: Bilateral STN stimulation is more effective than unilateral Pallidotomy in reducing parkinsonian symptoms in patients with advanced PD.
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bilateral Pallidotomy in parkinson s disease a retrospective study
Movement Disorders, 2002Co-Authors: Rob M.a. De Bie, R. A.j. Esselink, Richard P Schuurman, Andries D Bosch, J D SpeelmanAbstract:We evaluated the effects of bilateral Pallidotomy in patients with advanced Parkinson's disease. Thirteen patients with Parkinson's disease had a staged bilateral Pallidotomy if they had severe response fluctuations, dyskinesias, painful dystonia, or bradykinesia despite optimum pharmacological treatment. Assessment scales were the Unified Parkinson's Disease Rating scale (UPDRS), the Schwab and England scale, and a questionnaire on the effects of disability in activities of daily living and adverse effects. Postoperative magnetic resonance imaging was evaluated for lesion location and extension. The median off-phase UPDRS motor score was reduced from 43.5 to 29 after the first Pallidotomy, and it was further reduced to 23.5 after the second Pallidotomy (n = 8). The UPDRS activities of daily living off-phase score improved from 28.5 to 20.5 after the first Pallidotomy and to 19 after the second Pallidotomy (n = 6). The Schwab and England scale off-phase score showed an improvement after both procedures, first from 40 to 60, and thereafter to 90 (n = 8). On-phase dyskinesias were reduced substantially. Eight patients had adverse effects, of whom five had problems with speech. One patient became hemiplegic due to a delayed infarction. Ten patients experienced further benefit from the second procedure. Bilateral Pallidotomy reduces dyskinesias. A second contralateral Pallidotomy may reduce parkinsonism, although to a lesser degree compared with the first Pallidotomy and with an increased risk for adverse effects. © 2002 Movement Disorder Society
R. A.j. Esselink - One of the best experts on this subject based on the ideXlab platform.
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long term superiority of subthalamic nucleus stimulation over Pallidotomy in parkinson disease
Neurology, 2009Co-Authors: R. M. A. De Bie, R. A.j. Esselink, Peter C. G. Nijssen, R J De Haan, Mathieu W P M Lenders, Van Teus Laar, P R Schuurman, Dirk Bosch, J D SpeelmanAbstract:The results of our multicenter randomized controlled trial comparing unilateral Pallidotomy with bilateral subthalamic nucleus (STN) stimulation in advanced Parkinson disease (PD) demonstrated that STN stimulation is more effective than Pallidotomy up to 1 year postoperatively.1,2 Here we present the 4-year follow-up of this trial. ### Methods. Thirty-four patients with advanced PD were randomly assigned to have unilateral Pallidotomy or bilateral STN stimulation. Inclusion and exclusion criteria and study methods were described previously.1,2 The 2 assessors were blinded to the treatment allocation during the complete follow-up. For patients allocated to unilateral Pallidotomy, the protocol allowed STN stimulation at least 6 months after Pallidotomy. Outcome measures were the off and on phase motor Unified Parkinson's Disease Rating Scale (UPDRS) scores,3 dyskinesia severity (Clinical Dyskinesias Rating Scale),4 functional status (activities of daily living [ADL] UPDRS),3 PD Quality of Life questionnaire,5 levodopa equivalent dose,2 and adverse events. Difference in median change scores (4 years follow-up minus baseline) between treatment groups were analyzed using the Mann-Whitney U test or Kruskal-Wallis rank test, when …
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Unilateral Pallidotomy versus bilateral subthalamic nucleus stimulation in Parkinson’s disease: one year follow-up of a randomised observer-blind multi centre trial
Acta Neurochirurgica, 2006Co-Authors: R. A.j. Esselink, R. M. A. De Bie, R J De Haan, P R Schuurman, D A Bosch, E. N. H. J. Steur, G. N. Beute, A. T. Portman, J D SpeelmanAbstract:Background . To investigate whether STN stimulation is more efficacious than unilateral Pallidotomy in advanced Parkinson’s disease (PD) one year after surgery. Method . Thirty-four patients with advanced PD were randomly assigned to unilateral Pallidotomy or bilateral STN stimulation. Outcome measures were parkinsonian symptoms in off and on phases (UPDRS 3), dyskinesias, functional status, Parkinson’s disease quality of life questionnaire, the effects on separate symptoms, timed tests, patient diaries, dopaminergic drugs changes, adverse effects, and global outcome scale. Patients were assessed before surgery, six months and one year after surgery. The primary outcome measure was the off phase UPDRS 3 at six months follow-up. Findings . The off phase UPDRS 3 score improved from 46.5 to 32 points in the Pallidotomy patients and from 51.5 to 24 in the STN stimulation patients ( p = 0.002). On phase UPDRS 3 and off phase Schwab and England functional scale improved significantly in favour of the STN stimulation patients. Dopaminergic drugs reduction was larger in the STN group although the difference between the treatment groups was not significant. One patient in each group had a major adverse effect. Conclusions . Bilateral STN stimulation is more efficacious than unilateral Pallidotomy in advanced PD up to one year after surgery.
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unilateral Pallidotomy versus bilateral subthalamic nucleus stimulation in pd a randomized trial
Neurology, 2004Co-Authors: R. A.j. Esselink, R. M. A. De Bie, Peter C. G. Nijssen, Michiel J. Staal, Harriet M M Smeding, R J De Haan, Mathieu W P M Lenders, P R Schuurman, D A Bosch, J D SpeelmanAbstract:Objective: To compare the efficacy of unilateral Pallidotomy and bilateral subthalamic nucleus (STN) stimulation in patients with advanced Parkinson disease (PD) in a randomized, observer-blind, multicenter trial. Methods: Thirty-four patients with advanced PD were randomly assigned to have unilateral Pallidotomy or bilateral STN stimulation. The primary outcome was the change from baseline to 6 months in the motor part of the Unified PD Rating Scale (motor UPDRS) in the off phase. Secondary outcomes were parkinsonian symptoms in the on phase (motor UPDRS), dyskinesias (Clinical Dyskinesia Rating Scale and dyskinesias UPDRS), functional status (activities of daily living UPDRS and Schwab and England scale), PD Quality of Life questionnaire, changes in drug treatment, and adverse effects. Results: The off phase motor UPDRS score improved from 46.5 to 37 points in the group of Pallidotomy patients and from 51.5 to 26.5 in the STN stimulation patients ( p = 0.002). Of the secondary outcome measures, on phase motor UPDRS and dyskinesias UPDRS improved significantly in favor of the STN stimulation patients. Reduction of antiparkinsonian drugs was greater after STN stimulation than after Pallidotomy. One patient in each group had a major adverse effect. Conclusions: Bilateral STN stimulation is more effective than unilateral Pallidotomy in reducing parkinsonian symptoms in patients with advanced PD.
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Bilateral Pallidotomy in Parkinson's disease: a retrospective study.
Movement disorders : official journal of the Movement Disorder Society, 2002Co-Authors: Rob M.a. De Bie, P. Richard Schuurman, R. A.j. Esselink, D. Andries Bosch, Johannes D. SpeelmanAbstract:We evaluated the effects of bilateral Pallidotomy in patients with advanced Parkinson's disease. Thirteen patients with Parkinson's disease had a staged bilateral Pallidotomy if they had severe response fluctuations, dyskinesias, painful dystonia, or bradykinesia despite optimum pharmacological treatment. Assessment scales were the Unified Parkinson's Disease Rating scale (UPDRS), the Schwab and England scale, and a questionnaire on the effects of disability in activities of daily living and adverse effects. Postoperative magnetic resonance imaging was evaluated for lesion location and extension. The median off-phase UPDRS motor score was reduced from 43.5 to 29 after the first Pallidotomy, and it was further reduced to 23.5 after the second Pallidotomy (n = 8). The UPDRS activities of daily living off-phase score improved from 28.5 to 20.5 after the first Pallidotomy and to 19 after the second Pallidotomy (n = 6). The Schwab and England scale off-phase score showed an improvement after both procedures, first from 40 to 60, and thereafter to 90 (n = 8). On-phase dyskinesias were reduced substantially. Eight patients had adverse effects, of whom five had problems with speech. One patient became hemiplegic due to a delayed infarction. Ten patients experienced further benefit from the second procedure. Bilateral Pallidotomy reduces dyskinesias. A second contralateral Pallidotomy may reduce parkinsonism, although to a lesser degree compared with the first Pallidotomy and with an increased risk for adverse effects.
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bilateral Pallidotomy in parkinson s disease a retrospective study
Movement Disorders, 2002Co-Authors: Rob M.a. De Bie, R. A.j. Esselink, Richard P Schuurman, Andries D Bosch, J D SpeelmanAbstract:We evaluated the effects of bilateral Pallidotomy in patients with advanced Parkinson's disease. Thirteen patients with Parkinson's disease had a staged bilateral Pallidotomy if they had severe response fluctuations, dyskinesias, painful dystonia, or bradykinesia despite optimum pharmacological treatment. Assessment scales were the Unified Parkinson's Disease Rating scale (UPDRS), the Schwab and England scale, and a questionnaire on the effects of disability in activities of daily living and adverse effects. Postoperative magnetic resonance imaging was evaluated for lesion location and extension. The median off-phase UPDRS motor score was reduced from 43.5 to 29 after the first Pallidotomy, and it was further reduced to 23.5 after the second Pallidotomy (n = 8). The UPDRS activities of daily living off-phase score improved from 28.5 to 20.5 after the first Pallidotomy and to 19 after the second Pallidotomy (n = 6). The Schwab and England scale off-phase score showed an improvement after both procedures, first from 40 to 60, and thereafter to 90 (n = 8). On-phase dyskinesias were reduced substantially. Eight patients had adverse effects, of whom five had problems with speech. One patient became hemiplegic due to a delayed infarction. Ten patients experienced further benefit from the second procedure. Bilateral Pallidotomy reduces dyskinesias. A second contralateral Pallidotomy may reduce parkinsonism, although to a lesser degree compared with the first Pallidotomy and with an increased risk for adverse effects. © 2002 Movement Disorder Society
Federico Vigevano - One of the best experts on this subject based on the ideXlab platform.
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Pallidotomy for medically refractory status dystonicus in childhood
Developmental Medicine & Child Neurology, 2014Co-Authors: Carlo Efisio Marras, Michele Rizzi, Laura Cantonetti, Erika Rebessi, Francesco Portaluri, Franco Randi, Alessandra Savioli, Enrico Castelli, Alessandro De Benedictis, Federico VigevanoAbstract:Aim Status dystonicus is a rare and potentially fatal condition of continuous and generalized muscle contraction that can complicate dystonia. As status dystonicus is usually refractory to traditional pharmacological therapy, alternative and invasive strategies have been developed, but so far there are no guidelines on status dystonicus management. Pallidotomy has shown good results in status dystonicus treatment. Method We report indications, surgical strategy, and outcome of bilateral Pallidotomy in four pediatric patients (four males; mean age at surgery 11y 5mo) with secondary dystonia, who developed refractory status dystonicus. Pallidotomy was performed in the area corresponding to the mid portion of the globus pallidus internus. Results This procedure allowed patients to recover the pre-status dystonicus condition, controlling dystonic postures and movements of trunk and limbs. Moreover oromandibular dystonia, which is resistant to conservative approaches and deep brain stimulation, was significantly reduced. No postoperative complications were registered. Interpretation Our study suggests Pallidotomy as a feasible treatment in patients with secondary dystonia complicated by status dystonicus.
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Pallidotomy for medically refractory status dystonicus in childhood.
Developmental medicine and child neurology, 2014Co-Authors: Carlo Efisio Marras, Michele Rizzi, Laura Cantonetti, Erika Rebessi, Francesco Portaluri, Franco Randi, Alessandra Savioli, Enrico Castelli, Alessandro De Benedictis, Federico VigevanoAbstract:Status dystonicus is a rare and potentially fatal condition of continuous and generalized muscle contraction that can complicate dystonia. As status dystonicus is usually refractory to traditional pharmacological therapy, alternative and invasive strategies have been developed, but so far there are no guidelines on status dystonicus management. Pallidotomy has shown good results in status dystonicus treatment. We report indications, surgical strategy, and outcome of bilateral Pallidotomy in four pediatric patients (four males; mean age at surgery 11y 5mo) with secondary dystonia, who developed refractory status dystonicus. Pallidotomy was performed in the area corresponding to the mid portion of the globus pallidus internus. This procedure allowed patients to recover the pre-status dystonicus condition, controlling dystonic postures and movements of trunk and limbs. Moreover oromandibular dystonia, which is resistant to conservative approaches and deep brain stimulation, was significantly reduced. No postoperative complications were registered. Our study suggests Pallidotomy as a feasible treatment in patients with secondary dystonia complicated by status dystonicus. © 2014 Mac Keith Press.
Joseph Jankovic - One of the best experts on this subject based on the ideXlab platform.
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Five-year follow-up of unilateral posteroventral Pallidotomy in Parkinson's disease.
Surgical neurology, 2008Co-Authors: Adriana M. Strutt, Joseph Jankovic, Robert G. Grossman, Eugene C. Lai, Farah Atassi, Elizabeth M. Soety, Harvey S. Levin, Michele K. YorkAbstract:Abstract Background Neurocognitive outcome research of individuals with Parkinson's disease after unilateral Pallidotomy is inconsistent. Although some studies reported few cognitive changes, other investigations have more consistently shown both transient and long-term cognitive decline postoperatively. Methods We report the long-term motor and neurocognitive outcome 5 years post surgery for 18 patients with Parkinson's disease (12 men and 6 woman; all right-handed) who underwent right or left unilateral posteroventral Pallidotomy. Results Pallidotomy patients revealed long-term motor benefits from the surgery in their “off” state and control of dopa-induced dyskinesias in their “on” state, which is consistent with previous research. We found mild declines in oral and visuomotor information processing speed, verbal recognition memory, and mental status 5 years after surgery, which differs from previous literature regarding the long-term neurocognitive outcome after Pallidotomy. Differences between the right and left Pallidotomy patients for both motor and cognitive skills were not found. Conclusion Although deep brain stimulation is presently the treatment of choice, Pallidotomy continues to be performed around the world. Consequently, although unilateral Pallidotomy should be considered a treatment option for patients with Parkinson's disease who suffer from severe unilateral disabling motor symptoms or dyskinesias, the long-term neurocognitive outcome should also be considered in treatment decisions.
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subthalamic deep brain stimulation in patients with a previous Pallidotomy
Movement Disorders, 2006Co-Authors: William G. Ondo, Yavuz S. Silay, Mike Almaguer, Joseph JankovicAbstract:The safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients who have had a previous unilateral Pallidotomy is not clear. We identified 10 patients (9 male) at the Baylor College of Medicine Parkinson's Disease Center who underwent STN DBS after prior unilateral Pallidotomy. Demographics, efficacy as determined by off Unified Parkinson's Disease Rating Scale (UPDRS) part III scores, and levodopa equivalent dosing were analyzed. We then compared these to an age- and sex-matched group of 25 DBS patients who had no prior Pallidotomy. After their initial Pallidotomy (mean age, 51.8 ± 10.8 years), the mean UPDRS motor off medicine scores improved from 51.3 ± 14.3 to 34.9 ± 12.8, and the UPDRS dyskinesia score improved from 1.8 ± 1.0 to 0.8 ± 0.7. Their STN DBS off UPDRS motor scores (mean age, 56.0 ± 10.2 years) improved by 16.0% from 53.1 ± 9.7 (range, 42–68) to 44.6 ± 11.1 (range, 25–67). In contrast, the UPDRS off motor scores in a control group of 25 DBS patients improved by 49.9%, from 49.7 ± 11.1 to 25.7 ± 18.9, (16.0% vs. 49.9%; P < 0.001). Changes in UPDRS dyskinesia scores were similar in both groups. AE thought to be related to the STN DBS following Pallidotomy included worse dysarthria (three) and worse balance (two). STN DBS patients with prior Pallidotomy had less improvement in UPDRS off motor score compared to other STN DBS patients, despite relatively good outcomes immediately after their Pallidotomy. This may be partially due to a selection bias, but it may also indicate that prior Pallidotomy is a negative predictor of outcome of STN DBS and should be considered in patient selection. © 2006 Movement Disorder Society
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Subthalamic deep brain stimulation in patients with a previous Pallidotomy.
Movement disorders : official journal of the Movement Disorder Society, 2006Co-Authors: William G. Ondo, Yavuz S. Silay, Mike Almaguer, Joseph JankovicAbstract:The safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients who have had a previous unilateral Pallidotomy is not clear. We identified 10 patients (9 male) at the Baylor College of Medicine Parkinson's Disease Center who underwent STN DBS after prior unilateral Pallidotomy. Demographics, efficacy as determined by off Unified Parkinson's Disease Rating Scale (UPDRS) part III scores, and levodopa equivalent dosing were analyzed. We then compared these to an age- and sex-matched group of 25 DBS patients who had no prior Pallidotomy. After their initial Pallidotomy (mean age, 51.8 +/- 10.8 years), the mean UPDRS motor off medicine scores improved from 51.3 +/- 14.3 to 34.9 +/- 12.8, and the UPDRS dyskinesia score improved from 1.8 +/- 1.0 to 0.8 +/- 0.7. Their STN DBS off UPDRS motor scores (mean age, 56.0 +/- 10.2 years) improved by 16.0% from 53.1 +/- 9.7 (range, 42-68) to 44.6 +/- 11.1 (range, 25-67). In contrast, the UPDRS off motor scores in a control group of 25 DBS patients improved by 49.9%, from 49.7 +/- 11.1 to 25.7 +/- 18.9, (16.0% vs. 49.9%; P < 0.001). Changes in UPDRS dyskinesia scores were similar in both groups. AE thought to be related to the STN DBS following Pallidotomy included worse dysarthria (three) and worse balance (two). STN DBS patients with prior Pallidotomy had less improvement in UPDRS off motor score compared to other STN DBS patients, despite relatively good outcomes immediately after their Pallidotomy. This may be partially due to a selection bias, but it may also indicate that prior Pallidotomy is a negative predictor of outcome of STN DBS and should be considered in patient selection.
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Comparison of thalamotomy and Pallidotomy for the treatment of dystonia.
Neurosurgery, 2001Co-Authors: Daniel Yoshor, Winifred J. Hamilton, William G. Ondo, Joseph Jankovic, Robert G. GrossmanAbstract:OBJECTIVE: Thalamotomy and, more recently, Pallidotomy have been used to treat selected patients with intractable dystonia, although few studies have compared the effectiveness of these two surgical procedures. In this study, we compare our results using thalamotomy and Pallidotomy to treat patients with different forms of dystonia, and we discuss our results in the context of other published series. METHODS: Thirty-two patients with intractable dystonia underwent thalamotomy (n = 18) or Pallidotomy (n = 14). Dystonia was classified according to cause and distribution, and each patient was evaluated postoperatively at two or more time points, using a global outcome scale. RESULTS: Although comparisons are limited by differences between the two surgical groups, including longer follow-up periods for the thalamotomy group, differences in symptom distribution, and more bilateral procedures for the Pallidotomy group, patients with primary dystonia who underwent pallidotomies demonstrated significantly better long-term outcomes than did patients who underwent thalamotomies (P = 0.0467). Patients with secondary dystonia experienced more modest improvements after either procedure, with little or no difference in outcomes between the two procedures. CONCLUSION: For patients with primary dystonia, Pallidotomy seems to result in better outcomes than does thalamotomy.
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weight gain following unilateral Pallidotomy in parkinson s disease
Acta Neurologica Scandinavica, 2000Co-Authors: William G. Ondo, Joseph Jankovic, Eugene C. Lai, Charles F. Contant, L Benaire, Robert G. GrossmanAbstract:Objective - To determine the clinical correlates and infer pathogenesis of weight gain following Pallidotomy in patients with Parkinson's disease (PD). Background - Surgical ablation of the globus pallidus internus (GPi) improves levodopa induced dyskinesias, moderately improves most other cardinal' manifestations of PD, and has been noted to result in increased weight. Methods - We incorporated Unified Parkinson's Disease Rating Scales (UPDRS) subscales, the Beck depression inventory and feeding questionnaire data into a linear regression model in order to determine which post-surgical change(s) may lead to weight gain over the first year following Pallidotomy, n = 60. Results - The mean weight gain 1 year after Pallidotomy was 4.0±4.1 kg. Improvement in off motor scores (P < 0.005), especially gait subscores (P < 0.0001), and to a lesser extent improvement in on' motor scores (P<0.05) predicted weight gain. Changes in dyskinesia ratings, mood, food intake, dysphagia, levodopa dose, weight loss in the year prior to Pallidotomy, age, and duration of PD did not correlate with subsequent weight gain. Conclusion - The high correlation between post-Pallidotomy weight gain and off motor scores, suggests that this phenomenon is related to some change in underlying homeostasis associated with changes in the cardinal manifestations of PD itself, rather than secondary changes resultant from the surgery.
Aleksandar Beric - One of the best experts on this subject based on the ideXlab platform.
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Subthalamic nucleus stimulation in patients with a prior Pallidotomy
Journal of neurosurgery, 2002Co-Authors: Alon Y. Mogilner, Patrick J. Kelly, Djordje Sterio, Ali R. Rezai, Martin Zonenshayn, Aleksandar BericAbstract:Object. A substantial number of patients with Parkinson disease (PD) who have undergone unilateral stereotactic Pallidotomy ultimately develop symptom progression, becoming potential candidates for further surgical treatment. Bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) has been shown to be effective in the treatment of a subset of patients with refractory PD. Microelectrode recording is performed to help localize the STN and guide final placement of the electrode. Potential alterations in physiological features of the STN after Pallidotomy may complicate localization of this structure in this group of patients. Methods. Bilateral STN DBS surgery guided by microelectrode recording was performed in six patients who had undergone previous unilateral pallidotomies. Physiologically obtained parameters of the STN, including trajectory length, mean firing rate, cell number, and cell density were calculated. These data were compared with those from the side without prior Pallidotomy within each patient, as well as with those from our series of 49 subthalamic nuclei explored in 26 patients who had not undergone prior Pallidotomy but who underwent bilateral STN stimulator placement. In all patients, analysis of STN cellular activity on the side ipsilateral to the Pallidotomy demonstrated a lower mean firing frequency than on the contralateral, intact side. The physiological features on the intact side were not significantly different from those found in our series of patients who had not undergone prior Pallidotomy. Conclusions. Physicians who perform STN surgery in patients with prior Pallidotomy should be aware of the electrophysiological differences between the STN that had undergone Pallidotomy and the one that had not, to avoid prolonging recording time to search for the typical STN. The implications of these findings for the current models of information processing in the basal ganglia are discussed.
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Cognitive functioning after Pallidotomy for refractory Parkinson’s disease
Journal of neurology neurosurgery and psychiatry, 1998Co-Authors: Kenneth Perrine, Michael Dogali, E. Fazzini, D. Sterio, Edwin H. Kolodny, David Eidelberg, Orrin Devinsky, Aleksandar BericAbstract:Earlier approaches to Pallidotomy for refractory Parkinson's disease had significant complication rates. More recent approaches show fewer complications, but the effect of Pallidotomy on cognition is unclear. The current study was conducted to examine the neuropsychological effects of unilateral Pallidotomy. Neuropsychological testing was performed on patients with medically refractory, predominantly unilateral Parkinson's disease at baseline and after unilateral ventral Pallidotomy (n=28) or after an equivalent period without surgery in control patients (n=10). Pallidotomy patients showed no significant changes from baseline to retesting relative to the control group for any measure. Across all of the tests administered, only five of the surgery patients showed a significant decline, and of these five none declined on more than one test. Depression did not relate to preoperative or postoperative cognition. The Pallidotomy group showed a significant improvement in motor functioning and activities of daily living whereas the control group did not. These measures were not associated with the neuropsychological test scores at baseline or retest. Stereotactic unilateral ventral Pallidotomy does not seem to produce dramatic cognitive declines in most patients.
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cognitive functioning after Pallidotomy for refractory parkinson s disease
Journal of Neurology Neurosurgery and Psychiatry, 1998Co-Authors: Kenneth Perrine, Michael Dogali, E. Fazzini, D. Sterio, Edwin H. Kolodny, David Eidelberg, Orrin Devinsky, Aleksandar BericAbstract:BACKGROUND—Earlier approaches to Pallidotomy for refractory Parkinson's disease had significant complication rates. More recent approaches show fewer complications, but the effect of Pallidotomy on cognition is unclear. The current study was conducted to examine the neuropsychological effects of unilateral Pallidotomy. METHODS—Neuropsychological testing was performed on patients with medically refractory, predominantly unilateral Parkinson's disease at baseline and after unilateral ventral Pallidotomy (n=28) or after an equivalent period without surgery in control patients (n=10). RESULTS—Pallidotomy patients showed no significant changes from baseline to retesting relative to the control group for any measure. Across all of the tests administered, only five of the surgery patients showed a significant decline, and of these five none declined on more than one test. Depression did not relate to preoperative or postoperative cognition. The Pallidotomy group showed a significant improvement in motor functioning and activities of daily living whereas the control group did not. These measures were not associated with the neuropsychological test scores at baseline or retest. CONCLUSIONS—Stereotactic unilateral ventral Pallidotomy does not seem to produce dramatic cognitive declines in most patients.