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Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
Pallidotomy: Lesions in the posteroventral portion of the GPi presumably reduce the inhibitory output from the medial globus pallidus and thereby improve many of the ‘off’ period symptoms of PD (tremor, rigidity, and bradykinesia on the side contralateral to the surgery and some elements of gait). Lesions may also reduce levodopa-induced dyskinesias by up to 75%.However, they do not improve the patient's level of function when ‘on’ except for elimination of peak-dose levodopa-induced dyskinesias. Midline symptoms, such as postural instability and abnormal gait, also improve less. Any improvements are immediate and sustained for at least 6 months.Complications include homonymous hemianopia (up to 14%), facial paresis (up to 51%), and hemiparesis (up to 4%).
The viva: the non-operative clinical practice of neurosurgery
Published in Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad, Neurosurgery, 2014
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad
Pallidotomy directly destroys a portion of the internal segment of the globus pallidus (GPi), interrupting pallidofungal pathways or diminishing inputs to the medial pallidum (including the subthalamic nucleus).
Lesion Surgery for Parkinson's Disease: Practical Aspects of New Developments
Published in Lucien Côté, Lola L. Sprinzeles, Robin Elliott, Austin H. Kutscher, Parkinson's Disease and Quality of Life, 2014
This chapter will focus on presenting a neurosurgeon's perspective on the practical aspects of performing surgical lesions, or implanting brain stimulators, in an attempt to improve the symptoms of Parkinson's disease. Thalamotomy has been the most widely performed surgery for Parkinson's disease, dating back more than 35 years now. Thalamotomy has been very effective in alleviating one of the symptoms of Parkinson's, tremor. Recently a better understanding of the neural circuitry involved in Parkinson's and review of the early experience with pallidotomy has led to an increasing application of lesions in the globus pallidus (pallidotomy) which has helped patients with Parkinson's disease. It is important to note that pallidotomy has the potential to improve the most disabling features of Parkinson's disease and also alleviate tremor in many patients. Parkinson's is a slowly progressive disease that eventually causes severe functional impairment. Prior to the availability of L-Dopa and other medications, Parkinson's patients rapidly became disabled and a variety of brain lesions were performed in an attempt to alleviate symptoms. L-Dopa and other therapies dramatically changed the approach to Parkinson's disease.
Can therapeutic strategies prevent and manage dyskinesia in Parkinson’s disease? An update
Published in Expert Opinion on Drug Safety, 2019
Valentina Leta, Peter Jenner, K. Ray Chaudhuri, Angelo Antonini
Unilateral pallidotomy is an effective anti-dyskinetic surgical treatment for PD. The first high-quality randomized clinical trial in this field (N = 36) was led by Vitek and colleagues in 2003. The authors showed that unilateral pallidotomy was superior to medical therapy in reducing LID as measured by the UPDRS part IV at 6-month follow-up [160]. The anti-dyskinetic properties of unilateral pallidotomy were supported by further investigations led by Essekink et al. comparing unilateral pallidotomy with STN-DBS: both the 1-year and 4-year-follow up results revealed that unilateral pallidotomy improved dyskinesia and no significant differences were found between the two surgical procedures for this outcome measure (change in Clinical Dyskinesias Rating Scale) [161,162]. However, in clinical practice unilateral pallidotomy is now rarely performed, while DBS is available owing to the possible motor and non-motor emergent side effects.
Surgical treatment of dystonia
Published in Expert Review of Neurotherapeutics, 2018
Rubens Gisbert Cury, Suneil Kumar Kalia, Binit Bipin Shah, Joohi Jimenez-Shahed, Lingappa Kumar Prashanth, Elena Moro
The success of pallidotomy in treating dyskinesia and dystonia in PD inspired interest for this target to be used in treating isolated generalized dystonia, with striking benefits [106]. An analysis of 12 patients with idiopathic or inherited, isolated, generalized dystonia showed an improvement by 61% of the motor BFMDRS scores at 3 to 6 months after unilateral or bilateral pallidotomy, while in 40 patients with acquired, combined dystonia the mean improvement was less robust (20%) [107]. Long-term studies are scarce. In another study, five out of eight patients with idiopathic, isolated dystonia experienced marked amelioration after a mean of 10.6 months on the Global Outcome Scale, and two out of six with acquired, combined dystonia also experienced evident improvement 13.8 months after surgery [108]. The most frequent side effects after pallidotomy are dysarthria, visual field defects, facial weakness, hypophonia, dysphagia [109–111], and are at greater risk of occurrence following bilateral procedures.
Staged pallidotomy: MRI and clinical follow-up in status dystonicus
Published in British Journal of Neurosurgery, 2019
Angelo Franzini, Vincenzo Levi, Andrea Franzini, Ivano Dones, Giuseppe Messina
When such procedures prove to be inefficient an invasive approach is recommended. Intrathecal baclofen, tried in a small proportion of these patients, has shown to be only partially effective, and to harbor various serious risks such as withdrawal syndrome and overdosage.8,9,10 Stereotactic thalamotomy,11 pallidotomy,2,12 and Deep brain stimulation (DBS) of the Globus Pallidus Internus (GPi)13,14 have been performed with success in reverting SD.