In idiopatic Parkinson's disease (IPD) the firing rate in the subthalamic nucleus (STN) is abnormally increased, leading to augmented activity in the globus pallidum internum and, as a consequence, to a cortical inhibition. Benabid and Pollak first proposed (1993) chronic bilateral STN stimulation in patients with a severe akinetic form of IPD. This therapeutic approach provided a dramatic improvement of all parkinsonian symptoms. We report here our experience with STN stimulation in IPD. Between June'96 and May'97 five patients (four women and one man) affected by severe IPD were selected. All suffered for a long time from disabling motor fluctations, off-periods with generalized tremor and many choreic-dystonic abnormal involuntary movements during onperiods. Their general conditions were satisfactory. Cerebral MRI and neuropsychological evaluation were performed before surgery, The implants were carried out by means of an up-graded Talairach stereotactic frame under ventriculography guidance. The target was localized based on AC-PC line and the electrodes were implanted when a low stimulation intensity was able to reduce rigidity, tremor and bradikynesia. In four patients bilateral STN stimulation induced a significant improvement of parkinsonian symptoms, especially tremor and rigidity ;consequentely, the daily amount of antiparkinsonian drugs could be reduced. In one patient we observed no effect because there was bilateral lead migration.Bilateral STN stimulation provided a significant clinical benefit in patients affected by severe IPD. Our data confirm the effectiveness of this kind of pacing in the treatment of IPD.
|Number of pages||1|
|Journal||Italian Journal of Neurological Sciences|
|Publication status||Published - 1997|
ASJC Scopus subject areas
- Clinical Neurology