TY - JOUR
T1 - Multi-target strategy for Parkinsonian patients
T2 - The role of deep brain stimulation in the centromedian-parafascicularis complex
AU - Stefani, Alessandro
AU - Peppe, Antonella
AU - Pierantozzi, Mariangela
AU - Galati, Salvatore
AU - Moschella, Vincenzo
AU - Stanzione, Paolo
AU - Mazzone, Paolo
PY - 2009/2/16
Y1 - 2009/2/16
N2 - The intra-laminar (IL) thalamic complex, composed of centromedian (CM) and parafascicular (Pf) nucleus, is a strategic crossroad for the activity of the basal ganglia and is recently regaining its position has a putative neurosurgical target for Parkinsonian syndromes. The multi-target approach we have encouraged since the late nineties has allowed the combined implantation of a standard target (the subthalamic nucleus-STN or the internal pallidus-GPi) plus an innovative one (CM/Pf) in well-identified Parkinson's disease (PD) patients; hence, it is possible to study, in the same PD patients, the specific target-mediated effects on different clinical signs. Here, we focus on the potential usefulness of implanting the CM/Pf complex when required in the management of contra-lateral tremor (resistant to standard deep brain stimulation-DBS - in STN -, n = 2) and disabling involuntary movements, partially responsive to GPi-DBS (n = 6). When considering global UPDRS scores, CM/Pf-DBS ameliorate extra-pyramidal symptoms but not as strongly as STN (or GPi) does. Yet, CM/Pf acts very powerfully on tremor and contributes to the long-term management of l-Dopa-induced involuntary movements. The lack of cognitive deficits and psychic impairment associated with the improvement of their quality of life, in our small cohort of CM/Pf implanted patients, reinforces the notion of CM/Pf as a safe and attractive area for surgical treatment of advanced PD, possibly affecting not only motor but also associative functions.
AB - The intra-laminar (IL) thalamic complex, composed of centromedian (CM) and parafascicular (Pf) nucleus, is a strategic crossroad for the activity of the basal ganglia and is recently regaining its position has a putative neurosurgical target for Parkinsonian syndromes. The multi-target approach we have encouraged since the late nineties has allowed the combined implantation of a standard target (the subthalamic nucleus-STN or the internal pallidus-GPi) plus an innovative one (CM/Pf) in well-identified Parkinson's disease (PD) patients; hence, it is possible to study, in the same PD patients, the specific target-mediated effects on different clinical signs. Here, we focus on the potential usefulness of implanting the CM/Pf complex when required in the management of contra-lateral tremor (resistant to standard deep brain stimulation-DBS - in STN -, n = 2) and disabling involuntary movements, partially responsive to GPi-DBS (n = 6). When considering global UPDRS scores, CM/Pf-DBS ameliorate extra-pyramidal symptoms but not as strongly as STN (or GPi) does. Yet, CM/Pf acts very powerfully on tremor and contributes to the long-term management of l-Dopa-induced involuntary movements. The lack of cognitive deficits and psychic impairment associated with the improvement of their quality of life, in our small cohort of CM/Pf implanted patients, reinforces the notion of CM/Pf as a safe and attractive area for surgical treatment of advanced PD, possibly affecting not only motor but also associative functions.
KW - Deep brain stimulation
KW - Intra-laminar thalamic nuclei
KW - Parkinson's disease
UR - http://www.scopus.com/inward/record.url?scp=58749092010&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=58749092010&partnerID=8YFLogxK
U2 - 10.1016/j.brainresbull.2008.08.007
DO - 10.1016/j.brainresbull.2008.08.007
M3 - Article
C2 - 18812214
AN - SCOPUS:58749092010
VL - 78
SP - 113
EP - 118
JO - Brain Research Bulletin
JF - Brain Research Bulletin
SN - 0361-9230
IS - 2-3
ER -