Multi-target strategy for Parkinsonian patients: The role of deep brain stimulation in the centromedian-parafascicularis complex

Alessandro Stefani, Antonella Peppe, Mariangela Pierantozzi, Salvatore Galati, Vincenzo Moschella, Paolo Stanzione, Paolo Mazzone

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)113-118
Number of pages6
JournalBrain Research Bulletin
Volume78
Issue number2-3
DOIs
Publication statusPublished - Feb 16 2009

Keywords

  • Deep brain stimulation
  • Intra-laminar thalamic nuclei
  • Parkinson's disease

ASJC Scopus subject areas

  • Neuroscience(all)

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