Deep brain stimulation (DBS) is an effective treatment for selected patients with disabling Parkinson's disease (PD). The two main targets are the subthalamic nucleus (STN) and the globus pallidus internus (GPi), although it has not been established whether stimulation at one target is superior to the other. This prospective randomized study assessed the effects of unilateral DBS of the STN versus GPi on fine motor skills in 33 patients with advanced PD. Stimulation of either the STN (18 subjects) or GPi (15 subjects) in the off medication state significantly improved movement time and dexterity, but had little or no effect on reaction time. Overall, the extent of improvement did not differ between the two targets. The degree of improvement in movement time, but not dexterity, was correlated with the extent of preoperative medication responsiveness. Our findings suggest that DBS of the STN or GPi results in a similar improvement in hand movements at short-term follow-up. Preoperative medication responsiveness predicts improvement in some but not other motor tasks.
"More recently, altered patterns of neuronal activity in the form of increased bursting and greater synchronization (Brown et al., 2004; Brown and Williams, 2005; Gatev et al., 2006; Maurer et al., 2004; Nini et al., 1995; Raz et al., 2000; Wichmann et al., 1994b; Wichmann et al., 2002) as well as a widening of receptive fields to proprioceptive input (Filion et al., 1988; Leblois et al., 2006; Vitek et al., 1998) have been reported to occur in GPi in the parkinsonian state. And while a causal relationship between these changes and the cardinal features of PD has yet to be determined, it is clear that therapeutic benefit can be achieved for patients with PD through exogenous modulation of pallidal activity (Baron et al., 2002; Bergman et al., 1990; Burchiel et al., 1999; Nakamura et al., 2007; Rodriguez-Oroz et al., 2005; Vitek et al., 2003; Weaver et al., 2005). As currently performed, such procedures involve the targeting and, in most centers, the identification of the sensorimotor region of the GPi, followed by either radiofrequency ablation or the implantation of a deep brain stimulation (DBS) lead for chronic electrical stimulation. "
[Show abstract][Hide abstract] ABSTRACT: Ablation or deep brain stimulation in the internal segment of the globus pallidus (GPi) is an effective therapy for the treatment of Parkinson's disease (PD). Yet many patients receive only partial benefit, including varying levels of improvement across different body regions, which may relate to a differential effect of GPi surgery on the different body regions. Unfortunately, our understanding of the somatotopic organization of human GPi is based on a small number of studies with limited sample sizes, including several based upon only a single recording track or plane. To fully address the three-dimensional somatotopic organization of GPi, we examined the receptive field properties of pallidal neurons in a large cohort of patients undergoing stereotactic surgery. The response of neurons to active and passive movements of the limbs and orofacial structures was determined, using a minimum of three tracks across at least two medial-lateral planes. Neurons (3183) were evaluated from 299 patients, of which 1972 (62%) were modulated by sensorimotor manipulation. Of these, 1767 responded to a single, contralateral body region, with the remaining 205 responding to multiple and/or ipsilateral body regions. Leg-related neurons were found dorsal, medial and anterior to arm-related neurons, while arm-related neurons were dorsal and lateral to orofacial-related neurons. This study provides a more detailed map of individual body regions as well as specific joints within each region and provides a potential explanation for the differential effect of lesions or DBS of the GPi on different body parts in patients undergoing surgical treatment of movement disorders.
[Show abstract][Hide abstract] ABSTRACT: The current study examined cognitive effects of unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients. Neuropsychological evaluations were conducted at baseline and follow-up. Data was collected from 28 unilateral STN DBS patients (15 English- and 13 Spanish-speaking), and 15 English-speaking matched PD control patients. English-speaking DBS patients demonstrated significant declines in verbal fluency and attention/executive function, whereas PD control patients did not experience significant cognitive decline. Cognitive performance did not differ based on side of DBS. Spanish-speaking DBS patients experienced significant declines in verbal fluency, confrontational naming and visuospatial abilities. Among Spanish-speaking DBS patients, older age and later age of disease onset predicted verbal fluency decline, even after controlling for education.
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Interventions for the symptomatic control of motor complicationsRecommendations for the symptomatic control of motor complicationsInterventions and recommendations for the symptomatic control of non-motor problemsReferences
European Handbook of Neurological Management, 01/2008: pages 245 - 265; , ISBN: 9780470753279
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