Abstract
Objectives. Traditional deep brain stimulation (DBS) at the subthalamic nucleus (STN) has proved to be efficacious on core Parkinsonian symptoms. However, very disabling l-dopa-induced abnormal involuntary movements (AIMs) and axial signs are slightly affected, suggesting that we target less conventional targets. Our candidates for DBS were the globus pallidus internus (GPi) plus the intralaminar thalamic complex (Pf or CM), given its extensive functional links with basal ganglia nuclei. Materials and Methods. The routine utilization of our innovative stereotactic apparatus allows us to implant, at the same time, both the CM-Pf complex together with the GPi in six Parkinson disease patients. Both intraoperative and postoperative neurophysiologic assessments helped us recognize functional subregions while optimizing implantation of electrodes. Unified Parkinson disease rating scale (UPDRS) motor scores, AIMs, and freezing were carefully blindly evaluated for each condition. Results. A significant amelioration of UPDRS scores was achieved by simultaneous activation of both targets. CM-Pf activation was only slightly effective in reducing rigidity and akinesia, but more efficacious on freezing. Not surprisingly, AIMs were peculiarly decreased by the activation of the permanent electro-catheter in the posteroventral GPi. Conclusions. These findings confirm that, in selected patients, it is conceivable to target structures other than the conventional STN in order to maximize clinical benefit.
| Original language | English |
|---|---|
| Pages (from-to) | 221-228 |
| Number of pages | 8 |
| Journal | Neuromodulation |
| Volume | 9 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Jul 2006 |
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Keywords
- Deep brain stimulation (DBS)
- Dyskinesias
- Extrapyramidal disorders
- Freezing
- Intrathalamic complex nuclei
- Parkinson disease (PD)
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine
- Neuroscience(all)
Cite this
Bilateral implantation of centromedian-parafascicularis complex and GPi : A new combination of unconventional targets for deep brain stimulation in severe Parkinson disease. / Mazzone, Paolo; Stocchi, Fabrizio; Galati, Salvatore; Insola, Angelo; Altibrandi, Maria Grazia; Modugno, Nicola; Tropepi, Domenicantonio; Brusa, Livia; Stefani, Alessandro.
In: Neuromodulation, Vol. 9, No. 3, 07.2006, p. 221-228.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Bilateral implantation of centromedian-parafascicularis complex and GPi
T2 - A new combination of unconventional targets for deep brain stimulation in severe Parkinson disease
AU - Mazzone, Paolo
AU - Stocchi, Fabrizio
AU - Galati, Salvatore
AU - Insola, Angelo
AU - Altibrandi, Maria Grazia
AU - Modugno, Nicola
AU - Tropepi, Domenicantonio
AU - Brusa, Livia
AU - Stefani, Alessandro
PY - 2006/7
Y1 - 2006/7
N2 - Objectives. Traditional deep brain stimulation (DBS) at the subthalamic nucleus (STN) has proved to be efficacious on core Parkinsonian symptoms. However, very disabling l-dopa-induced abnormal involuntary movements (AIMs) and axial signs are slightly affected, suggesting that we target less conventional targets. Our candidates for DBS were the globus pallidus internus (GPi) plus the intralaminar thalamic complex (Pf or CM), given its extensive functional links with basal ganglia nuclei. Materials and Methods. The routine utilization of our innovative stereotactic apparatus allows us to implant, at the same time, both the CM-Pf complex together with the GPi in six Parkinson disease patients. Both intraoperative and postoperative neurophysiologic assessments helped us recognize functional subregions while optimizing implantation of electrodes. Unified Parkinson disease rating scale (UPDRS) motor scores, AIMs, and freezing were carefully blindly evaluated for each condition. Results. A significant amelioration of UPDRS scores was achieved by simultaneous activation of both targets. CM-Pf activation was only slightly effective in reducing rigidity and akinesia, but more efficacious on freezing. Not surprisingly, AIMs were peculiarly decreased by the activation of the permanent electro-catheter in the posteroventral GPi. Conclusions. These findings confirm that, in selected patients, it is conceivable to target structures other than the conventional STN in order to maximize clinical benefit.
AB - Objectives. Traditional deep brain stimulation (DBS) at the subthalamic nucleus (STN) has proved to be efficacious on core Parkinsonian symptoms. However, very disabling l-dopa-induced abnormal involuntary movements (AIMs) and axial signs are slightly affected, suggesting that we target less conventional targets. Our candidates for DBS were the globus pallidus internus (GPi) plus the intralaminar thalamic complex (Pf or CM), given its extensive functional links with basal ganglia nuclei. Materials and Methods. The routine utilization of our innovative stereotactic apparatus allows us to implant, at the same time, both the CM-Pf complex together with the GPi in six Parkinson disease patients. Both intraoperative and postoperative neurophysiologic assessments helped us recognize functional subregions while optimizing implantation of electrodes. Unified Parkinson disease rating scale (UPDRS) motor scores, AIMs, and freezing were carefully blindly evaluated for each condition. Results. A significant amelioration of UPDRS scores was achieved by simultaneous activation of both targets. CM-Pf activation was only slightly effective in reducing rigidity and akinesia, but more efficacious on freezing. Not surprisingly, AIMs were peculiarly decreased by the activation of the permanent electro-catheter in the posteroventral GPi. Conclusions. These findings confirm that, in selected patients, it is conceivable to target structures other than the conventional STN in order to maximize clinical benefit.
KW - Deep brain stimulation (DBS)
KW - Dyskinesias
KW - Extrapyramidal disorders
KW - Freezing
KW - Intrathalamic complex nuclei
KW - Parkinson disease (PD)
UR - http://www.scopus.com/inward/record.url?scp=33845602261&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33845602261&partnerID=8YFLogxK
U2 - 10.1111/j.1525-1403.2006.00063.x
DO - 10.1111/j.1525-1403.2006.00063.x
M3 - Article
C2 - 22151710
AN - SCOPUS:33845602261
VL - 9
SP - 221
EP - 228
JO - Neuromodulation
JF - Neuromodulation
SN - 1094-7159
IS - 3
ER -