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Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease

Gross, Robert E. ; Lombardi, Wendy J. ; Lang, Anthony E. ; Duff, Jan ; Hutchison, William D. ; Saint-Cyr, Jean A. ; Tasker, Ronald R. ; Lozano, Andres M.

Brain (London, England : 1878), 1999-03, Vol.122 (3), p.405-416 [Periódico revisado por pares]

Oxford: Oxford University Press

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Título:
Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease
Autor: Gross, Robert E. ; Lombardi, Wendy J. ; Lang, Anthony E. ; Duff, Jan ; Hutchison, William D. ; Saint-Cyr, Jean A. ; Tasker, Ronald R. ; Lozano, Andres M.
Assuntos: Aged ; Biological and medical sciences ; clinical outcome ; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases ; Dyskinesia, Drug-Induced - physiopathology ; Female ; Functional Laterality ; Gait ; globus pallidus ; Globus Pallidus - pathology ; Globus Pallidus - surgery ; GPe = globus pallidus externus ; GPi = globus pallidus internus ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Microelectrodes ; Middle Aged ; Motor Activity ; Muscle Rigidity - physiopathology ; Neurology ; Neurosurgical Procedures ; pallidotomy ; Parkinson Disease - pathology ; Parkinson Disease - physiopathology ; Parkinson Disease - surgery ; Parkinson's disease ; Posture ; Prospective Studies ; Regression Analysis ; Treatment Outcome ; Tremor - physiopathology ; UPDRS = Unified Parkinson's Disease Rating Scale ; vMRI = volumetric MRI
É parte de: Brain (London, England : 1878), 1999-03, Vol.122 (3), p.405-416
Notas: local:1220405
ark:/67375/HXZ-G3JN1PJS-3
Dr R. E. Gross, Division of Neurosurgery, The Toronto Hospital, Western Division, 399 Bathurst Street, McL 2-433, Toronto, Ontario, Canada M5T 2S8
istex:4D01AE3918DE153E9C542F7C713A50DD95E26B5C
ObjectType-Article-2
SourceType-Scholarly Journals-1
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Descrição: The purpose of this study was to examine the relationship between lesion location and clinical outcome following globus pallidus internus (GPi) pallidotomy for advanced Parkinson's disease. Thirty-three patients were prospectively studied with extensive neurological examinations before and at 6 and 12 months following microelectrode-guided pallidotomy. Lesion location was characterized using volumetric MRI. The position of lesions within the posteroventral region of the GPi was measured, from anteromedial to posterolateral along an axis parallel to the internal capsule. To relate lesion position to clinical outcome, hierarchical multiple regression analysis was used. The variance in outcome measures that was related to preoperative scores and lesion volume was first calculated, and then the remaining variance attributable to lesion location was determined. Lesion location along the anteromedial-to-posterolateral axis within the GPi influenced the variance in total score on the Unified Parkinson's Disease Rating Scale in the postoperative `off' period, and in `on' period dyskinesia scores. Within the posteroventral GPi, anteromedial lesions were associated with greater improvement in `off' period contralateral rigidity and `on' period dyskinesia, whereas more centrally located lesions correlated with better postoperative scores of contralateral akinesia and postural instability/gait disturbance. Improvement in contralateral tremor was weakly related to lesion location, being greater with posterolateral lesions. We conclude that improvement in specific motor signs in Parkinson's disease following pallidotomy is related to lesion position within the posteroventral GPi. These findings are consistent with the known segregated but parallel organization of specific motor circuits in the basal ganglia, and may explain the variability in clinical outcome after pallidotomy and therefore have important therapeutic implications.
Editor: Oxford: Oxford University Press
Idioma: Inglês

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Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease

Gross, Robert E. ; Lombardi, Wendy J. ; Lang, Anthony E. ; Duff, Jan ; Hutchison, William D. ; Saint-Cyr, Jean A. ; Tasker, Ronald R. ; Lozano, Andres M.

Oxford: Oxford University Press

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