Study on the function of the basal ganglia and frontal cortex using depth microrecording and PET scan in relation to the outcome of pallidotomy for the treatment of rigid-akinesia-type Parkinson's disease

Pallidotomy for parkinson disease: a review of contemporary literature

OBJECT

The authors conducted an evidence-based review of contemporary published articles on pallidotomy to obtain an appraisal of this procedure in the treatment of Parkinson disease (PD).

METHODS

A search of the Pubmed database performed using the key word "pallidotomy" yielded 263 articles cited between January 1, 1992, and July 1, 1999. Articles that included original, nonduplicated descriptions of patients with PD treated with radiofrequency pallidotomy were selected. In 85 articles identified for critical review, 1959 patients with PD underwent pallidotomies at 40 centers in 12 countries. There were 1735 unilateral (88.6%) and 224 bilateral procedures (11.4%). The mean age of the patients was 61.4+/-3.6 years and the mean duration of PD symptoms in these patients was 12.3+/-1.9 years. Microelectrode recordings were used in 46.2% of cases. Outcomes were objectively documented using the Unified Parkinson Disease Rating Scale (UPDRS) in 501 (25.6%) of the cases at 6 months and in 218 (11.1%) of the cases at 1 year. There was a consensus on the benefits of pallidotomy for off period motor function and on period, drug-induced dyskinesias, with variations in the extent of symptomatic benefit across studies. At the 1-year assessment, the mean improvement in the UPDRS motor score during off periods was 45.3% and the mean improvement in contralateral dyskinesias during on periods was 86.4%. The overall mortality rate was 0.4% and the rate of persistent adverse effects was estimated at 14%. Major adverse events, including intracerebral hemorrhages, contralateral weakness, and visual field defects, occurred in 5.3% of patients reported.

CONCLUSIONS

Unilateral pallidotomy is effective and relatively safe in the treatment of PD; however, limited data are available on the long-term outcome of this procedure.

Dopamine imaging markers and predictive mathematical models for progressive degeneration in Parkinson's disease

We conducted PET imaging studies of modulation of dopamine transporter function and MRS studies of neurochemicals in idiopathic primate Parkinson's disease (PD) model induced by long-term, low-dose administration of MPTP. MR spectra showed striking similarities of the control spectrum of the primate and human striatum as well as MPTP-treated primate (six months after cessation of MPTP), and Parkinson's disease patient striatum (68 year old male; Hoehn-Yahr scale II; 510 mg/d L-DOPA). The choline/creatine ratio was similar in the MPTP model and human parkinsonism, suggesting a possible glial abnormality. The progressive degeneration of dopamine re-uptake sites observed in our PD model can be expressed by a time dependent exponential equation N(t) = N0 exp (-(0.072 +/- 0.016) t), where N0 represents intact entities (dopamine re-uptake sites before MPTP) and 0.072 per month is the rate of degeneration. When the signs of PD appear, N(t) is about 0.3-0.4 times N0. Interestingly, this biological degenerative phenomena has similar progression to that observed in cell survival theory. According to this theory and calculated degeneration rate, predictive models can be produced for regeneration and protective treatments.