The Basal Ganglia VI

Although the internal segment of the globus pallidus (GPi) has been a neurosurgical target for some 50 years, only recently has a detailed analysis of the clinical effects of interventions in this region been made. This is largely the result of new surgical options for the large number of patients that remain poorly managed after many years of anti-parkinson medication and advances in stereotactic functional neurosurgery including imaging. A short review is given of microelectrode techniques used for targeting the GPi for pallidotomy and deep brain stimulation (DBS) procedures. Analysis of neuronal fIring rates suggest that GPi outflow is hyperactive in unmedicated PD patients. This is further supported by observations that the administration of apomorphine reduces the fIring rate of single neurons recorded in the GPi of PD patients. Finally, an overview is provided of the clinical outcome of these procedures and what they suggest about the pathophysiology of GPi and its role in PD symptomatology.

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