What happened to posteroventral pallidotomy for Parkinson’s disease and dystonia? Authors
Cite this article as: Gross, R.E. Neurotherapeutics (2008) 5: 281. doi:10.1016/j.nurt.2008.02.001
Fifteen years after its resurrection, pallidotomy for Parkinson’s disease (PD) and dystonia has once again been supplanted, this time by deep brain stimulation (DBS). Did this occur because pallidotomy was not effective or safe, or because DBS was found to be more effective and safer? This review focuses on the evidence—and its quality—supporting the effectiveness and safety of pallidotomy for PD and dystonia, and the comparative effectiveness and safety of DBS of the subthalamic nucleus (STN) and globus pallidus pars interna (GPi). Discussed first are the determinants of “level 1” recommendations, including the confounding effects on interpretation of randomized clinical trials (RCTs) that fail to control for patient bias (i.e., placebo effects). Although several RCTs have been performed comparing unilateral pallidotomy to medical therapy, GPi DBS, or STN DBS for PD, none controlled for patient bias. Comparison of these trials to estimate the placebo effect, and examination of retrospective case series, suggests that the true effectiveness of unilateral pallidotomy is 20% to 30% reduction of ’off total motor UPDRS scores, which is similar to the effects of unilateral GPi DBS or STN DBS, but less than bilateral STN DBS. At experienced centers, safety of unilateral pallidotomy appears equivalent to unilateral DBS, but bilateral DBS is likely safer than bilateral pallidotomy. Whereas there have been no RCTs of pallidotomy for dystonia, two double-blind, sham-controlled RCTs of bilateral GPi DBS were performed. Nevertheless, limited uncontrolled series suggest that bilateral pallidotomy is similar to GPi DBS in effectiveness and safety for dystonia. Thus, pallidotomy was not rejected because of lack of effectiveness or safety, and it remains a viable alternative in situations where DBS is not available or not feasible.
Tasker RR, Siqueira J, Hawrylyshyn P, Organ LW. What happened to VIM thalamotomy for Parkinson’s disease? Appl Neurophysiol 1983;46: 68–83.
Laitinen LV, Bergenheim AT, Hariz MI. Ventroposterolateral pallidotomy can abolish all parkinsonian symptoms. Stereotact Funct Neurosurg 1992;58: 14–21.
Hariz MI. From functional neurosurgery to “interventional” neurology: survey of publications on thalamotomy, pallidotomy, and deep brain stimulation for Parkinson’s disease from 1966 to 2001. Mov Disord 2003;18: 845–853.
Benabid AL, Pollak P, Gao D, et al. Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg 1996;84: 203–214.
van de Warrenburg BP, Bhatia KP, Quinn NP. Pisa syndrome after unilateral pallidotomy in Parkinson’s disease: an unrecognised, delayed adverse event? J Neurol Neurosurg Psychiatry 2007;78: 329–330.
York MK, Lai EC, Jankovic J, et al. Short and long-term motor and cognitive outcome of staged bilateral pallidotomy: a retrospective analysis. Acta Neurochir (Wien) 2007;149: 857–866; discussion 866.
Meyers R. Surgical procedure for postencephalitic tremor, with notes on the physiology of the premotor fibres. Arch Neurol Psychiatry 1940;44: 455–459.
Meyers R. Historical background and personal experiences in the surgical relief of hyperkinesia and hypertony. In: Fields WS, editor. Pathogenesis and treatment of parkinsonism; sixth annual scientific meeting of the Houston Neurological Society, Texas Medical Center, Houston, Texas. Springfield, IL: Charles C. Thomas, 1958: 229–270.
Guridi J, Lozano AM. A brief history of pallidotomy. Neurosurgery 1997;41: 1169–1180; discussion 1180–1183.
Narabayashi H, Okuma T. Procaine oil blocking of the globus pallidus for the treatment of rigidity and tremor of parkinsonism. Psychiatr Neurol Japonica 1953;56: 471–495.
Cooper IS. Ligation of the anterior choroidal artery for involuntary movements; parkinsonism. Psychiatr Q 1953;27: 317–319.
Spiegel E, Wycis H, Marks M, Lee AJ. Stereotaxic apparatus for operations on the human brain. Science 1947;106: 349–350.
Cooper IS. Surgical treatment of parkinsonism. Annu Rev Med 1965;16: 309–330.
Cooper IS, Bravo G. Chemopallidectomy and chemothalamectomy. J Neurosurg 1958;15: 244–250.
Hassler R. The pathological and pathophysiological basis of tremor and parkinsonism. In: Proceedings of the 2nd International Congress of Neuropathology, Excerpta Medica Foundation. Amsterdam: Excerpta Medica 1955;1: 29–40.
Hassler R, Riechert T, Mundinger F, Umbach W, Ganglberger JA. Physiological observations in stereotaxic operations in extrapyramidal motor disturbances. Brain 1960;83: 337–350.
Laitinen LV. Brain targets in surgery for Parkinson’s disease: results of a survey of neurosurgeons. J Neurosurg 1985;62: 349–351.
Laitinen LV. Pallidotomy for Parkinson’s disease. Neurosurg Clin N Am 1995;6: 105–112.
Svennilson E, Torvik A, Lowe R, Leksell L. Treatment of parkinsonism by stereotactic thermolesions in the pallidal region: a clinical evaluation of 81 cases. Acta Psychiatr Scand 1960;35: 358–377.
Laitinen LV, Bergenheim AT, Hariz MI. Leksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease. J Neurosurg 1992;76: 53–61.
Alexander GE, DeLong MR, Strick PL. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci 1986;9: 357–381.
DeLong MR, Crutcher MD, Georgopoulos AP. Primate globus pallidus and subthalamic nucleus: functional organization. J Neurophysiol 1985;53: 530–543.
Albin RL, Young AB, Penney JB. The functional anatomy of basal ganglia disorders. Trends Neurosci 1989;12: 366–375.
Miller WC, DeLong MR. Parkinsonian symptomatology: an anatomical and physiological analysis. Ann N Y Acad Sci 1988; 515: 287–302.
Rychetnik L, Frommer M, Hawe P, Shiell A. Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health 2002;56: 119–127.
Freeman TB, Vawter DE, Leaverton PE, et al. Use of placebo surgery in controlled trials of a cellular-based therapy for Parkinson’s disease. N Engl J Med 1999;341: 988–992.
Freed CR, Breeze RE, Fahn S. Placebo surgery in trials of therapy for Parkinson’s disease. N Engl J Med 2000;342: 353–354; author reply 354–355.
Freed CR, Greene PE, Breeze RE, et al. Transplantation of embryonic dopamine neurons for severe Parkinson’s disease. N Engl J Med 2001;344: 710–719.
Olanow CW, Goetz CG, Kordower JH, et al. A double-blind controlled trial of bilateral fetal nigral transplantation in Parkinson’s disease. Ann Neurol 2003;54: 403–414.
Bakay RA. Metaanalysis, pallidotomy, and microelectrodes. J Neurosurg 2002;97: 1253–1256; author reply 1256.
Palur RS, Berk C, Schulzer M, Honey CR. A metaanalysis comparing the results of pallidotomy performed using microelectrode recording or macroelectrode stimulation. J Neurosurg 2002;96: 1058–1062.
de Bie RM, de Haan RJ, Nijssen PC, et al. Unilateral pallidotomy in Parkinson’s disease: a randomised, single-blind, multicentre trial. Lancet 1999;354: 1665–1669.
Vitek JL, Bakay RA, Freeman A, et al. Randomized trial of pallidotomy versus medical therapy for Parkinson’s disease. Ann Neurol 2003;53: 558–569.
Lozano AM, Lang AE, Galvez-Jimenez N, et al. Effect of GPi pallidotomy on motor function in Parkinson’s disease [Erratum in: Lancet 1996;348:1108]. Lancet 1995;346: 1383–1387.
Gross RE, Lozano AM, Lang AE, Tasker RR, Hutchison WD, Dostrovsky JO. The effects of pallidotomy on Parkinson’s disease: study design and assessment techniques. Acta Neurochir Suppl 1997;68: 24–28.
Ondo WG, Jankovic J, Lai EC, et al. Assessment of motor function after stereotactic pallidotomy. Neurology 1998;50: 266–270.
de la Fuente-Fernández R, Ruth TJ, Sossi V, Schulzer M, Calne DB, Stoessl AJ. Expectation and dopamine release: mechanism of the placebo effect in Parkinson’s disease. Science 2001;293: 1164–1166.
Clark PI, Leaverton PE. Scientific and ethical issues in the use of placebo controls in clinical trials. Annu Rev Public Health 1994; 15: 19–38.
Lacritz LH, Cullum CM, Frol AB, Dewey RB Jr, Giller CA. Neuropsychological outcome following unilateral stereotactic pallidotomy in intractable Parkinson’s disease. Brain Cogn 2000; 42: 364–378.
McRae C, Cherin E, Yamazaki TG, et al. Effects of perceived treatment on quality of life and medical outcomes in a double-blind placebo surgery trial [Erratum in: Arch Gen Psychiatry 2004;61:627]. Arch Gen Psychiatry 2004;61: 412–420.
Esselink RA, de Bie RM, de Haan RJ, et al. Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD: a randomized trial. Neurology 2004;62: 201–207.
Esselink RA, de Bie RM, de Haan RJ, et al. Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in Parkinson’s disease: one year follow-up of a randomised observer-blind multi centre trial. Acta Neurochir (Wien) 2006;148: 1247–1255; discussion 1255.
Merello M, Nouzeilles MI, Kuzis G, et al. Unilateral radiofrequency lesion versus electrostimulation of posteroventral pallidum: a prospective randomized comparison. Mov Disord 1999; 14: 50–56.
Merello M, Nouzeilles MI, Cammarota A, Betti O, Leiguarda R. Comparison of 1-year follow-up evaluations of patients with indication for pallidotomy who did not undergo surgery versus patients with Parkinson’s disease who did undergo pallidotomy: a case control study. Neurosurgery 1999;44: 461–467; discussion 467–468.
Kishore A, Turnbull IM, Snow BJ, et al. Efficacy, stability and predictors of outcome of pallidotomy for Parkinson’s disease: six-month follow-up with additional 1-year observations. Brain 1997;120: 729–737.
Samii A, Turnbull IM, Kishore A, et al. Reassessment of unilateral pallidotomy in Parkinson’s disease: a 2-year follow-up study. Brain 1999;122: 417–425.
Fine J, Duff J, Chen R, et al. Long-term follow-up of unilateral pallidotomy in advanced Parkinson’s disease. N Engl J Med 2000;342: 1708–1714.
Hayward RS, Wilson MC, Tunis SR, Bass EB, Guyatt G. Users’ guides to the medical literature. VIII. How to use clinical practice guidelines. A. Are the recommendations valid? The Evidence-Based Medicine Working Group. JAMA 1995;274: 570–574.
Gross RE, Lozano AM. Stereotactic pallidotomy and thalamotomy. In: Factor SA, Weiner WJ, editors. Parkinson’s disease: diagnosis and clinical management. 2nd ed. New York: Demos Medical Publishing, 2008. p. 699–723.
Gross RE, Lombardi WJ, Hutchison WD, et al. Variability in lesion location after microelectrode-guided pallidotomy for Parkinson’s disease: anatomical, physiological, and technical factors that determine lesion distribution. J Neurosurg 1999;90: 468–477.
Gross RE, Lombardi WJ, Lang AE, et al. Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson’s disease. Brain 1999;122: 405–416.
Hariz MI, Bergenheim AT. A 10-year follow-up review of patients who underwent Leksell’s posteroventral pallidotomy for Parkinson disease. J Neurosurg 2001;94: 552–558.
Lombardi WJ, Gross RE, Trepanier LL, Lang AE, Lozano AM, Saint-Cyr JA. Relationship of lesion location to cognitive outcome following microelectrode-guided pallidotomy for Parkinson’s disease: support for the existence of cognitive circuits in the human pallidum. Brain 2000;123: 746–758.
Intemann PM, Masterman D, Subramanian I, et al. Staged bilateral pallidotomy for treatment of Parkinson disease. J Neurosurg 2001;94: 437–444.
Parkin SG, Gregory RP, Scott R, et al. Unilateral and bilateral pallidotomy for idiopathic Parkinson’s disease: a case series of 115 patients. Mov Disord 2002;17: 682–692.
Counihan TJ, Shinobu LA, Eskandar EN, Cosgrove GR, Penney JB Jr. Outcomes following staged bilateral pallidotomy in advanced Parkinson’s disease. Neurology 2001;56: 799–802.
Alkhani A, Lozano AM. Pallidotomy for Parkinson disease: a review of contemporary literature. J Neurosurg 2001;94: 43–49.
de Bie RM, de Haan RJ, Schuurman PR, Esselink RA, Bosch DA, Speelman JD. Morbidity and mortality following pallidotomy in Parkinson’s disease: a systematic review. Neurology 2002;58: 1008–1012.
Vitek JL, Bakay RA, Hashimoto T, et al. Microelectrode-guided pallidotomy: technical approach and its application in medically intractable Parkinson’s disease. J Neurosurg 1998;88: 1027–1043.
Limousin P, Martinez-Torres I. Deep brain stimulation for Parkinson’s disease. Neurotherapeutics 2008;5: 000–000 (this issue).
Kumar R, Lozano AM, Montgomery E, Lang AE. Pallidotomy and deep brain stimulation of the pallidum and subthalamic nucleus in advanced Parkinson’s disease. Mov Disord 1998;13 Suppl 1: 73–82.
Jiménez F, Velasco F, Carrillo-Ruiz JD, et al. Comparative evaluation of the effects of unilateral lesion versus electrical stimulation of the globus pallidus intemus in advanced Parkinson’s disease. Stereotact Funct Neurosurg 2006;84: 64–71.
Nakamura K, Christine CW, Starr PA, Marks WJ Jr. Effects of unilateral subthalamic and pallidal deep brain stimulation on fine motor functions in Parkinson’s disease. Mov Disord 2007;22: 619–626.
Germano IM, Gracies JM, Weisz DJ, Tse W, Koller WC, Olanow CW. Unilateral stimulation of the subthalamic nucleus in Parkinson disease: a double-blind 12-month evaluation study. J Neurosurg 2004;101: 36–42.
Slowinski JL, Putzke JD, Uitti RJ, et al. Unilateral deep brain stimulation of the subthalamic nucleus for Parkinson disease. J Neurosurg 2007;106: 626–632.
Chung SJ, Jeon SR, Kim SR, Sung YH, Lee MC. Bilateral effects of unilateral subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease. Eur Neurol 2006;56: 127–132.
Samii A, Kelly VE, Slimp JC, Shumway-Cook A, Goodkin R. Staged unilateral versus bilateral subthalamic nucleus stimulator implantation in Parkinson disease. Mov Disord 2007;22: 1476–1481.
Kleiner-Fisman G, Herzog J, Fisman DN, et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 2006;21 Suppl 14: S290-S304.
Merello M. Subthalamic stimulation contralateral to a previous pallidotomy: an erroneous indication? Mov Disord 1999; 14: 890.
Blomstedt P, Hariz GM, Hariz MI. Pallidotomy versus pallidal stimulation. Parkinsonism Relat Disord 2006;12: 296–301.
Gálvez-Jiménez N, Lozano A, Tasker R, Duff J, Hutchison W, Lang AE. Pallidal stimulation in Parkinson’s disease patients with a prior unilateral pallidotomy. Can J Neurol Sci 1998;25: 300–305.
Duma CM. Movement disorder radiosurgery: planning, physics and complication avoidance. Prog Neurol Surg 2007;20: 249–266.
Okun MS, Stover NP, Subramanian T, et al. Complications of gamma knife surgery for Parkinson disease. Arch Neurol 2001; 58: 1995–2002.
McIntosh E, Gray A, Aziz T. Estimating the costs of surgical innovations: the case for subthalamic nucleus stimulation in the treatment of advanced Parkinson’s disease. Mov Disord 2003;18: 993–999.
Chung SJ, Hong SH, Kim SR, Lee MC, Jeon SR. Efficacy and safety of simultaneous bilateral pallidotomy in advanced Parkinson’s disease. Eur Neurol 2006;56: 113–118.
Liu X, Wang H, Qian Z, Yang T, Gu Y. Method of localization of microelectrode in the globus pallidus during pallidotomy for Parkinson’s disease [In Chinese]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2007;24: 488–491.
Llumiguano C, Doczi T, Baths I. Microelectrode guided stereotactic pallidotomy and pallido-thalamotomy for treatment of Parkinson’s disease [In Spanish]. Neurocirugia (Astur) 2006; 17: 420–432.
Mourão LF, Aguiar PM, Ferraz FA, Behlau MS, Ferraz HB. Acoustic voice assessment in Parkinson’s disease patients submitted to posteroventral pallidotomy. Arq Neuropsiquiatr 2005; 63: 20–25.
Olzak M, Laskowska I, Jelonek J, et al. Psychomotor and executive functioning after unilateral posteroventral pallidotomy in patients with Parkinson’s disease. J Neurol Sci 2006;248: 97–103.
Tsai CH, Chang FC, Lu CS, et al. Pallidotomy effect on the cortical excitability in patients with severe Parkinson’s disease. Mov Disord 2005;20: 463–470.
Yen CP, Wu SJ, Su YF, Kwan AL, Howng SL, Shih PY. Unilateral stereotactic posteroventral globus pallidus internus pallidotomy for Parkinson’s disease: surgical techniques and 2-year follow-up. Kaohsiung J Med Sci 2005;21: 1–8.
Bergman H, Wichmann T, DeLong MR. Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science 1990;249: 1436–1438.
Aziz TZ, Peggs D, Sambrook MA, Crossman AR. Lesion of the subthalamic nucleus for the alleviation of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism in the primate. Mov Disord 1991;6: 288–292.
Alvarez L, Macias R, Guridi J, et al. Dorsal subthalamotomy for Parkinson’s disease. Mov Disord 2001;16: 72–78.
Alvarez L, Macias R, Lopez G, et al. Bilateral subthalamotomy in Parkinson’s disease: initial and long-term response. Brain 2005; 128: 570–583.
Patel NK, Heywood P, O’Sullivan K, McCarter R, Love S, Gill SS. Unilateral subthalamotomy in the treatment of Parkinson’s disease. Brain 2003;126: 1136–1145.
Su PC, Tseng HM, Liu HM, Yen RF, Liou HH. Treatment of advanced Parkinson’s disease by subthalamotomy: one-year results. Mov Disord 2003;18: 531–538.
Vilela Filho O, da Silva DJ. Unilateral subthalamic nucleus lesioning: a safe and effective treatment for Parkinson’s disease. Arq Neuropsiquiatr 2002;60: 935–948.
Krack P, Vercueil L. Review of the functional surgical treatment of dystonia. Eur J Neurol 2001;8: 389–399.
Iacono RP, Kuniyoshi SM, Lonser RR, Maeda G, Inae AM, Ashwal S. Simultaneous bilateral pallidoansotomy for idiopathic dystonia musculorum deformans. Pediatr Neurol 1996;14: 145–148.
Lozano AM, Kumar R, Gross RE, et al. Globus pallidus intemus pallidotomy for generalized dystonia. Mov Disord 1997;12: 865–870.
Alkhani A, Bohlega S. Unilateral pallidotomy for hemidystonia. Mov Disord 2006;21: 852–855.
Cersosimo MG, Raina GB, Piedimonte F, Antico J, Graff P, Micheli FE. Pallidal surgery for the treatment of primary generalized dystonia: long-term follow-up. Clin Neurol Neurosurg 2008;110: 145–150.
Choi SJ, Lee SW, Kim MC, et al. Posteroventral pallidotomy in medically intractable postapoplectic monochorea: case report. Surg Neurol 2003;59: 486–490; discussion 490.
Cubo E, Shannon KM, Penn RD, Kroin JS. Internal globus pallidotomy in dystonia secondary to Huntington’s disease. Mov Disord 2000;15: 1248–1251.
Eltahawy HA, Saint-Cyr J, Giladi N, Lang AE, Lozano AM. Primary dystonia is more responsive than secondary dystonia to pallidal interventions: outcome after pallidotomy or pallidal deep brain stimulation. Neurosurgery 2004;54: 613–619; discussion 619–621.
Ford B. Pallidotomy for generalized dystonia. Adv Neurol 2004; 94: 287–299.
Imerz M, Ozeren B, Karadereler S, et al. Destructive stereotactic surgery for treatment of dystonia. Surg Neurol 2005;64 Suppl 2: S89-S94; discussion S94-85.
Justesen CR, Penn RD, Kroin JS, Egel RT. Stereotactic pallidotomy in a child with Hallervorden—Spatz disease: case report. J Neurosurg 1999;90: 551–554.
Lai T, Lai JM, Grossman RG. Functional recovery after bilateral pallidotomy for the treatment of early-onset primary generalized dystonia. Arch Phys Med Rehabil 1999;80: 1340–1342.
Lin JJ, Lin GY, Shih C, Lin SZ, Chang DC, Lee CC. Benefit of bilateral pallidotomy in the treatment of generalized dystonia: case report. J Neurosurg 1999;90: 974–976.
Lin JJ, Lin SZ, Chang DC. Pallidotomy and generalized dystonia. Mov Disord 1999;14: 1057–1059.
Lin JJ, Lin SZ, Lin GY, Chang DC, Lee CC. Application of bilateral sequential pallidotomy to treat a patient with generalized dystonia. Eur Neurol 1998;40: 108–110.
Lin JJ, Lin SZ, Lin GY, Chang DC, Lee CC. Treatment of intractable generalized dystonia by bilateral posteroventral pallidotomy: one-year results. Zhonghua Yi Xue Za Zhi (Taipei) 2001;64: 231–238.
Ondo WG, Desaloms JM, Jankovic J, Grossman RG. Pallidotomy for generalized dystonia. Mov Disord 1998;13: 693–698.
Rakocevic G, Lyons KE, Wilkinson SB, Overman JW, Pahwa R. Bilateral pallidotomy for severe dystonia in an 18-month-old child with glutaric aciduria. Stereotact Funct Neurosurg 2004;82: 80–83.
Teive HA, Munhoz RP, Souza MM, et al. Status dystonicus: study of five cases. Arq Neuropsiquiatr 2005;63: 26–29.
Teive HA, Sá DS, Grande CV, Antoniuk A, Werneck LC. Bilateral pallidotomy for generalized dystonia. Arq Neuropsiquiatr 2001;59: 353–357.
Vitek JL, Zhang J, Evatt M, et al. GPi pallidotomy for dystonia: clinical outcome and neuronal activity. Adv Neurol 1998;78: 211–219.
Weetman J, Anderson IM, Gregory RP, Gill SS. Bilateral posteroventral pallidotomy for severe antipsychotic induced tardive dyskinesia and dystonia. J Neurol Neurosurg Psychiatry 1997;63: 554–556.
Yoshor D, Hamilton WJ, Ondo W, Jankovic J, Grossman RG. Comparison of thalamotomy and pallidotomy for the treatment of dystonia. Neurosurgery 2001;48: 818–824; discussion 824–826.
Iacono RP, Kuniyoshi SM, Schoonenberg T. Experience with stereotactics for dystonia: case examples. Adv Neurol 1998;78: 221–226.
Ostrem JL, Starr PA. Treatment of dystonia with deep brain stimulation. Neurotherapeutics 2008;5: 000–000 (this issue).
Kupsch A, Benecke R, Müller J, et al. Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 2006;355: 1978–1990.
Vidailhet M, Vercueil L, Houeto JL, et al. Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. N Engl J Med 2005;352: 459–467.
Vidailhet M, Vercueil L, Houeto JL, et al. Bilateral, pallidal, deep-brain stimulation in primary generalised dystonia: a prospective 3 year follow-up study. Lancet Neurol 2007;6: 223–229.
Eltahawy HA, Feinstein A, Khan F, Saint-Cyr J, Lang AE, Lozano AM. Bilateral globus pallidus internus deep brain stimulation in tardive dyskinesia: a case report. Mov Disord 2004;19: 969–972.
Franzini A, Marras C, Ferroli P, et al. Long-term high-frequency bilateral pallidal stimulation for neuroleptic-induced tardive dystonia: report of two cases. J Neurosurg 2005; 102: 721–725.
Trottenberg T, Volkmann J, Deuschl G, et al. Treatment of severe tardive dystonia with pallidal deep brain stimulation. Neurology 2005;64: 344–346.
Zhang JG, Zhang K, Wang ZC. Deep brain stimulation in the treatment of tardive dystonia. Chin Med J (Engl) 2006;119: 789–792.
© The American Society for Experimental NeuroTherapeutics, Inc. 2008