Acta Neurochirurgica

, Volume 137, Issue 1–2, pp 106–112

Chronic anterior pallidal stimulation for parkinson's disease

  • R. P. Iacono
  • R. R. Lonser
  • G. Maeda
  • S. Kuniyoshi
  • D. Warner
  • G. Mandybur
  • Sh. Yamada
Special Cases


We present the case of a 51-year-old female who had a four-year history of Parkinson's disease with severe “on-off ” and disabling progression of symptoms on chronic levodopa therapy.

After obtaining FDA approval, we implanted a Medtronic deep brain stimulation lead stereotactically into the right anterior pallidum contralateral to her most Symptomatologic side. Intra-operative stimulation trials at 100 Hz caused reproducible reversal of akinetic symptoms and simultaneous microelectrode recording of the posteroventral pallidum revealed decreased neural activity during anterior pallidal stimulation.

The patient was evaluated pre-operatively and postoperatively using the Hoehn and Yahr Staging Scale, the Unified Parkinson's Disease Rating Scale (UPDRS), videotape, and a computerized data glove. Six months after implantation, the total UPDRS score was decreased from 68 to 8 and Hoehn and Yahr Staging improved from 3.0 to 1.5 during periods of chronic high frequency stimulation. Dramatic improvements in tremor, dystonia, bradykinesia, and akinesia were noted within seconds of stimulator activation and were also objectively measured using a computerized data glove. This case reveals the potential for therapeutic pallidal stimulation for Parkinson's akinetic symptomatology.


Akinesia deep brain electrical stimulation akinesia globus pallidum Parkinson's disease 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    An KN, Jacobsen C, Berglund LJ, Chao EYS (1988) Application of a magnetic tracking device to kinesiologic studies. J Biomech 21 (7): 613–620Google Scholar
  2. 2.
    Aziz TZ, Peggs D, Sambrook MA, Crossman AR (1991) Lesion of the subthalamic nucleus for the alleviation of 1-methyl-4-phenyl-1,2,3,6-tetrahydrophyridine (MPTP)-induced parkinsonism in the primate. Mov Disord 6 (4): 288–292Google Scholar
  3. 3.
    Benabid AL, Pollak P, Gervason C, Hoffmann D, Gao DM, Hommel M, Perret JE, De Rougemont J (1991) Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet 337: 403–406Google Scholar
  4. 4.
    Blond S, Siegfried J (1991) Thalamic stimulation for the treatment of tremor and other movement disorders. Acta Neurochir (Wien) [Suppl] 52: 109–111Google Scholar
  5. 5.
    Brotchie JM, Mitchell IJ, Sambrook MA, Crossman AR (1991) Alleviation of parkinsonism by antagonism of excitatory amino acid transmission in the medial segment of the globus pallidus in rat and primate. Mov Disord 6 (2): 133–138Google Scholar
  6. 6.
    Carpenter MB (1991) Corpus striatum and related nuclei. In: Carpenter MB (ed) Core text of neuroanatomy, 4th Ed. Williams and Wilkins, pp 325–360Google Scholar
  7. 7.
    Crossman AR, Jackson A (1983) Nucleus tegmenti pedunculo-pontinus: efferent connections with special reference to the basal ganglia, studied in the rat by anterograde and retrograde transport of horseradish peroxidase. Neuroscience 10 (3): 725–765Google Scholar
  8. 8.
    De Vito JL, Anderson ME (1982) An autoradiographic study of efferent connections of the globus pallidus in macana mulatta. Exper Brain Res 46: 107–117Google Scholar
  9. 9.
    Filion M, Tremblay L (1991) Abnormal spontaneous activity of globus pallidus neurons in monkey with MPTP-induced parkinsonian. Brain Res 547: 142–151Google Scholar
  10. 10.
    Filion M, Tremblay L, Bedard PJ (1991) Effects of dopamine agonists on the spontaneous activity of globus pallidus in monkeys with MPTP-induced parkinsonian. Brain Res 547: 152–161Google Scholar
  11. 11.
    Hammond C, Rouzaire-Dubois B, Feger J, Jackson A, Cross-man AR (1983) Anatomical and electrophysiological studies on the reciprocal projections between the subthalamic nucleus and nucleus tegmenti pedunculopontinus in the rat. Neuroscience 9 (1): 41–52Google Scholar
  12. 12.
    Hassler R (1979) Stereotaxis in Parkinson's syndrome. Springer, New York, p 166Google Scholar
  13. 13.
    Horak FB, Anderson ME (1984) Influence of globus pallidus on arm movements in monkeys. II. Effects of Stimulation. J Neurophysiol 52 (2): 305–322Google Scholar
  14. 14.
    Iacono RP, Lonser R (1994) Reversal of akinesia of pallidotomy. Lancet 34: 418–419Google Scholar
  15. 15.
    Iacono RP, Mandybur G, Lonser R, Yamada S (1995) Stimulation of the globus pallidus in Parkinson's disease. Br J NeurosurgGoogle Scholar
  16. 16.
    Kavaklis O, Shima F, Kato M, Fukui M (1992) Ipsilateral pallidal control on the sternocleidomastoid muscle in cats: relationship to the side of thalamotomy for torticollis. Neurosurgery, 30 (5): 724–731Google Scholar
  17. 17.
    Kim R, Nakano K, Jayaraman A, Carpenter MB: projections of the globus pallidus and adjacent structures: an autoradiographic study in the monkey. J Comp Neurol 169: 263–290Google Scholar
  18. 18.
    Laitinen LV, Bergenheim AT, Hariz MI (1992) Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 76: 53–61Google Scholar
  19. 19.
    Lang AE (1990) Clinical rating scales and videotape analysis. In: Koller WC, Parlson G (eds) Therapy of Parkinson's disease. Marcel Dekker, New YorkGoogle Scholar
  20. 20.
    Marsden CD (1990) Parkinson's disease. Review article Lancet 948–952Google Scholar
  21. 21.
    Martinez-Martin P, Gil-Nagel A, Gracia LM, Gomez JB, Martinez-Sarries J, Bermejo F (1994) Unified Parkinson's disease rating scale characteristics and structure. Mov Disord 9 (9): 76–83Google Scholar
  22. 22.
    Milner KL, Mogenson GJ (1988) Electrical and chemical activation of the mesencephalic and subthalamic locomotor regions in freely moving rats. Brain Res 452: 273–285Google Scholar
  23. 23.
    Narabayashi H (1990) Surgical treatment in the levodopa era. In: Stern G (ed) Parkinson's disease. Chapman and Hall, London, pp 597–646Google Scholar
  24. 24.
    Peppe A, Dambrosia J, Chase T (1993) Risk factors for motor response complications in L-DOPA-treated parkinsonian patients. Ad Neurol 60: 698–702Google Scholar
  25. 25.
    Percheron G, Filion M, Tremblay L, Fenelon G, Francois C, Yelnik J (1993) The role of the medial pallidum in the pathophysiology of akinesia in primates. Ad Neurol 60: 84–87Google Scholar
  26. 26.
    Poewe W (1993) Clinical and pathophysiologic aspects of late levodopa failure. Neurology 43 [Suppl] 6: S28-S30Google Scholar
  27. 27.
    Sandyk R, Iacono RP (1988) The relationship of the reticular system to the primary pathoetiology of Parkinson's disease. Intern J Neurosci 42: 297–300Google Scholar
  28. 28.
    Shima F, Sakata S, Sun SJ, Kato M, Fukui M, lacono RP (1994) The role of the descending pallido-reticular pathway in movement disorders. Monogr Neurol SciGoogle Scholar
  29. 29.
    Siegfried J (1991) Therapeutic neurostimulation-indications reconsidered. Acta Neurochir (Wien) [Suppl] 52: 112–117Google Scholar
  30. 30.
    Siegfried J, Lippitz B (1994) Bilateral chronic electric stimulation of Ventroposterolateral pallidum; a new therapeutic approach for alleviating all Parkinsonian symptoms. Neurosurgery 35 (6): 1126–1130Google Scholar
  31. 31.
    Spencer DD, Robbins RJ, Naftolin F, Phil D, Marek KL, Voll-mer T, Leranth C, Roth RH, Price LH, Gjedde A, Bunney BS, Sass KJ, Elsworth JD, Kier L, Makuch R, Hoffer PB, Redmond DE (1992) Unilateral transplantation of human fetal mesencephalic tissue into the caudate nucleus of patients with Parkinson's disease. New Engl J Med 327 (22): 1541–1548Google Scholar
  32. 32.
    Spiegel EA, Wycis HT, Szekely EG, Soloff L, Adams J, Gildenberg PH, Zanes CH (1964) Stimulation of Forel's field during stereotactic operations in the human brain. Electroencephal Clin Neurophysiol 16: 537–548Google Scholar
  33. 33.
    Svennilson E, Torvik A, Lowe R, Leksell L (1960) Treatment of parkinsonism by stereotactic thermolesions in pallidal region. Psychiatr Neurol Scand 35: 358–377Google Scholar
  34. 34.
    Wise S, Gardner W, Sabelman E, Valainis E, Wong Y, Glass K, Drace J, Rosen JM (1990) Evaluation of a fiber optic glove for semi-automated goniometric measurements. J Rehab Res 72 (4): 411–424Google Scholar
  35. 35.
    Zweig RM, Jankel WR, Hedreen JC, Mayeux R, Price DL (1989) The pedunculopontine nucleus in Parkinson's disease. Am Neurol Assoc 26 (1): 41–46Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • R. P. Iacono
    • 1
  • R. R. Lonser
    • 1
  • G. Maeda
    • 1
  • S. Kuniyoshi
    • 1
  • D. Warner
    • 1
  • G. Mandybur
    • 1
  • Sh. Yamada
    • 1
  1. 1.Division of NeurosurgeryLoma Linda University Medical CenterLoma LindaUSA

Personalised recommendations