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Tsai CH, Chang FC, Lu CS, Lee ST, Huang YT, Lu MK, Chen RS, Wu T, Lee JD, Weng YH, Chang HC. Pallidotomy effect on the cortical excitability in patients with severe Parkinson's disease. Mov Disord 2005; 20:463-470. [PMID: 15593137 DOI: 10.1002/mds.20344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Surgical lesions in the medial pallidum have been shown to ameliorate motor deficits in patients with Parkinson's disease (PD). It is believed that interruption of the pallidothalamocortical projections to the motor cortex is required for the satisfactory results. In this report, we adopt cortico-cortical inhibition as the tool to assess the pallidotomy effect on cortical excitability in PD. Interstimulus interval between 1 and 15 msec were investigated. The average peak-to-peak amplitude was measured and calculated at each delay. A total of 8 patients (M:F = 4:4) 54.9 years of age (SD = 9.6) and 10 controls were recruited for the study. In the controls, the inhibitory phenomenon was observed from the 1-msec to the 4-msec delay points and the maximal inhibition was at the 3-msec delay point (33.69% +/- 6.50% of the control response). Mild facilitation was noticed since the 5-msec delay point and thereafter. In patients before operation, a similar trend of inhibition was also observed in the initial 4 msec with the maximal inhibition also at the 3-msec delay point (64.66 +/- 6.77% of the control response). In the postoperative group, the short interstimulus interval inhibition can no longer be observed and the conditioned response was 95.06 +/- 23.68% of the control at the 3-msec delay point. The suppression was gone at and after the 7-msec delay point. Results of repeated-measures analysis of variance show a significant difference among the controls and PD patients before and 3 months after pallidotomy (F = 3.40, P = 0.05). Post hoc examination revealed a significant difference between the controls and PD patients 3 months after pallidotomy at the 3-msec delay point (P = 0.004). However, no correlation was observed between the 3-msec inhibition and the Unified Parkinson's Disease Rating Scale Motor score or the dyskinesia score. The results suggest that pallidotomy can modulate the cortical inhibitory circuitry in patients with PD.
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Affiliation(s)
- Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan, Republic of China
- Institute of Medical Science, China Medical University, Taichung, Taiwan, Republic of China
| | - Fang-Chia Chang
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chin-Song Lu
- Movement Disorders Unit, Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Yu-Ting Huang
- Movement Disorders Unit, Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Rou-Shayn Chen
- Movement Disorders Unit, Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Tony Wu
- Movement Disorders Unit, Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Jiann-Der Lee
- Department of Electrical Engineering, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Yi-Hsin Weng
- Movement Disorders Unit, Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Hsiu-Chen Chang
- Movement Disorders Unit, Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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Robertson LT, Horak FB, Anderson VC, Burchiel KJ, Hammerstad JP. Assessments of axial motor control during deep brain stimulation in parkinsonian patients. Neurosurgery 2001; 48:544-51; discussion 551-2. [PMID: 11270544 DOI: 10.1097/00006123-200103000-00017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We tested the hypothesis that bilateral deep brain stimulation (DBS) in the globus pallidus internus or the subthalamic nucleus improves various components of postural and oromotor function and that some of the components correlate with changes in the Unified Parkinson's Disease Rating Scale (UPDRS) in patients with Parkinson's disease. METHODS Six patients with Parkinson's disease were evaluated for four postural and two orofacial UPDRS items, and quantitative tests of posture adjustments and oromotor control were performed while the patients were on and off DBS. Measurements of postural adjustments included reactive force and latency before a voluntary step. The oromotor assessments involved velocity and amplitude changes during voluntary jaw movement. RESULTS DBS significantly improved the total UPDRS motor score by an average of 44%, which included improvement of 18 to 54% in the postural and orofacial items. DBS also decreased foot lift-off latency significantly, but it produced a variable response to the preparatory postural force in the swing limb. DBS significantly improved jaw-opening velocity by 14 to 50% and jaw opening amplitude by 5 to 41%. Significant correlations for the percentage change from off and on DBS occurred among a few UPDRS items and foot lift-off latency and jaw-opening velocities. CONCLUSION DBS in either the globus pallidus internus or the subthalamic nucleus induces improvements in bradykinesia of specific components of postural and oromotor control, which also can be measured by the postural and orofacial UPDRS items. In some Parkinson's disease patients, DBS results in improvements in force or amplitude control, although these changes are not reflected in changes in UPDRS postural and orofacial items. A battery of quantitative and clinical tests must be used to evaluate the effects of DBS on axial motor control adequately.
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Affiliation(s)
- L T Robertson
- Department of Biological Structure and Function, Oregon Health Sciences University, Portland 97201, USA.
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