Abstract
Chronic deep brain stimulation therapy has the reversibility, selectivity and adjustability needed to achieve an adequate effect, so that it represents an ideal tool for functional neurosurgery designed to treat parkinsonian symptoms. Some kinds of chronic stimulation have become an alternative to lesion-making surgery, supported by the fact that high-frequency stimulation induces quite a small area of inactivity around the stimulating electrode compared with the lesions induced with a lesionmaker, and stimulation directed at a particular target exerts more specific effects on particular symptoms of Parkinson’s disease (PD). Thus, whenever stimulation therapy is to be applied to patients, an effective stimulation target must be selected depending on the nature of the symptom to be improved. For example, ventral intermediate nucleus (VIM) thalamic stimulation is able to stop tremor completely, but has no appreciable effects on other symptoms. Bilateral globus pallidum interna (GPi) stimulation and subthalamic nucleus (STN) stimulation have been applied to reduce the pathological inhibitory effects on the thalamocortical circuit from the GPi and/or the substantia nigra pars reticular nucleus (SNr), which produces the final output of the basal ganglia circuits. However, there is still controversy about both the indications for and the role of GPi versus STN stimulation. This article presents a review of recent reports that describe follow-up results and double-blind studies on the signs for relief of each type of parkinsonian symptom, following GPi or STN stimulation. It also includes a discussion of how further research should be organized in order to identify whether GPi or STN stimulation exerts the greatest effect on particular kinds of parkinsonian symptoms.
Papers reviewed
Pahwa R, Wilkinson S, Smith RN, Lyons K, Miyawaki E, Koller WC (1997) High-frequency stimulation of the globus pallidus for the treatment of Parkinson’s disease. Neurology 49:249–253
Ghika J, Villemure JG, Frankhauser H, Favre J, Assal G, Dhika-Schmid F (1998) Efficiency and safety of bilateral contemporaneous pallidal stimulation in levodopa-responsive patients with Parkinson’s disease with severe motor fluctuation: a 2-year follow-up review. J Neurosurg 89:713–718
Bejjani B, Damier P, Arnulf I, Bonnet AM, Vidailhet M, Dormont D, Pidoux B, Cornu P, Marsault C, Agid Y (1997) Pallidal stimulation for Parkinson’s disease: two targets? Neurology 49:1564–1569
Tronnier VM, Fogel W, Kronenbuerger M, Steinvorth S (1997) Pallidal stimulation: an alternative to pallido-tomy? J Neurosurg 87:700–705
Limousin P, Pollak P, Benazzouz A, Hoffmann D, Francois J (1995) Effect on parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 345:91–95
Limousin P, Pollak P, Hoffmann D, Benazzouz A, Perret JE, Benabid AL (1996) Abnormal involuntary movements induced by subthalamic nucleus stimulation in parkinsonian patients. Mov Disord 3:231–235
Hutchinson WD, Allen RJ, Opitz H, Levy R, Dostrovsky JO, Lang AE, Lozano AM (1998) Neurophysiological identification of the subthalamic nucleus in surgery for Parkinson’s disease. Ann Neurol 44:622–628
Kumar R, Lozano AM, Kim YJ, Hutchinson WD, Sime E, Halket E, Lang AE (1998) Double-blind evalua-tion of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease. Neurology 51:850–855
Limousin P, Greene J, Pollak P, Rothwell J, Benabid AL, Frackowiak R (1997) Changes in cerebral activity pattern due to subthalamic nucleus or internal pallidum stimulation in Parkinson’s disease. Ann Neurol 42:283–291
Kumar R, Lozano AM, Montgomery E, Lang AE (1998) Pallidotomy and deep brain stimulation of the pallidum and subthalamic nucleus in advanced Parkinson’s disease. Mov Disord 13:73–82
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Tsubokawa, T., Katayama, Y. Deep brain stimulation for Parkinson’s disease: how to select candidates for pallidal or subthalamic stimulation. Crit Rev Neurosurg 9, 355–366 (2000). https://doi.org/10.1007/s003290050156
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DOI: https://doi.org/10.1007/s003290050156