Bilateral chronic electrostimulation of ventroposterolateral pallidum: a new therapeutic approach for alleviating all parkinsonian symptoms.

: The global improvement of all parkinsonian symptoms after stereotactic pallidotomy has been demonstrated by Leksell. Recently, Laitinen, re-evaluating this target in the neurosurgical treatment of Parkinson's disease, confirmed the real value of this approach, and emphasized the necessity of locating the lesion in the ventroposterolateral part of the pallidum internum. Because we know that high-frequency stimulation of the ventrolateral part of the thalamus has the same clinical effect on tremor as high-frequency coagulation, this technique has now been applied bilaterally in one session in three patients who have severe Parkinson's disease, with akinesia and levodopa-induced dyskinesias in the foreground. The very satisfactory clinical results, up to 12 months in the first case, confirm the observation of Laitinen, but with the difference that the approach discussed here is both nondestructive and reversible, and unwanted side effects are avoided.

[1]  B. Lippitz,et al.  Chronic electrical stimulation of the VL-VPL complex and of the pallidum in the treatment of movement disorders: personal experience since 1982. , 1994, Stereotactic and functional neurosurgery.

[2]  Y. Hosobuchi Subcortical electrical stimulation for control of intractable pain in humans. Report of 122 cases (1970-1984). , 1986, Journal of neurosurgery.

[3]  S Blond,et al.  Thalamic stimulation for the treatment of tremor and other movement disorders. , 1991, Acta neurochirurgica. Supplementum.

[4]  M. Hariz,et al.  Ventroposterolateral pallidotomy can abolish all parkinsonian symptoms. , 1992, Stereotactic and functional neurosurgery.

[5]  M. Hariz,et al.  Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. , 1992, Journal of neurosurgery.

[6]  J. Siegfried [Effect of stimulation of the sensory nucleus of the thalamus on dyskinesia and spasticity]. , 1986, Revue neurologique.

[7]  J. Siegfried,et al.  [A simple radiological technic for the localisation of foramen of Monro in plain skull x-rays (author's transl)]. , 1980, Neuro-Chirurgie.

[8]  P. Comte,et al.  Intracerebral electrode implantation system. Technical note. , 1983, Journal of neurosurgery.

[9]  A. Crossman Neural mechanisms in disorders of movement. , 1989, Comparative biochemistry and physiology. A, Comparative physiology.

[10]  Professor Dr. med. Rolf Hassler,et al.  Stereotaxis in Parkinson Syndrome , 1979, Springer Berlin Heidelberg.

[11]  J. Siegfried Effets de la stimulation du noyau sensitif du thalamus sur les dyskinésies et la spasticité. , 1986 .

[12]  D. Brooks,et al.  Core assessment program for intracerebral transplantations (CAPIT) , 1992, Movement disorders : official journal of the Movement Disorder Society.

[13]  J. Siegfried Therapeutical neurostimulation--indications reconsidered. , 1991, Acta neurochirurgica. Supplementum.

[14]  G. Rea,et al.  Advances in Neurostimulation Devices , 1988 .

[15]  R. Iansek The effects of reserpine on motor activity and pallidal discharge in monkeys: implications for the genesis of akinesia , 1980, The Journal of physiology.

[16]  L. Leksell,et al.  TREATMENT OF PARKINSONISM BY STEREOTACTIC THERMOLESIONS IN THE PALLIDAL REGION. A clinical evaluation of 81 cases. , 1960, Acta psychiatrica Scandinavica.

[17]  R A Bakay,et al.  Posteroventral pallidotomy for Parkinson's disease. , 1992, Journal of neurosurgery.

[18]  A. Benabid,et al.  Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus , 1991, The Lancet.

[19]  P. Strick,et al.  Multiple output channels in the basal ganglia. , 1993, Science.

[20]  G. Schaltenbrand,et al.  Atlas for Stereotaxy of the Human Brain , 1977 .

[21]  R. Porter,et al.  The monkey globus pallidus: neuronal discharge properties in relation to movement. , 1980, The Journal of physiology.