Skip to main content
SpringerLink
Log in

Bilateral Pallidotomy for Parkinson’s Disease

Costs and Benefits

  • Chapter
Surgical Treatment of Parkinson’s Disease and Other Movement Disorders

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Pallidotomy for alleviation of the symptoms of Parkinson’s disease (PD) is one of the oldest stereotactic procedures in functional neurosurgery. Early series described by Cooper (1), Speigel and Wycis (2), and Reichert (3) in the 1950s found rigidity was alleviated in 80% and tremor in about 45% of their patients with no effect on bradykinesia, although such an effect was claimed by Krayenbuhl in his series (4). With the more predictable suppression of tremor via a thalamic lesion, pallidotomy eventually fell out of favor. Later, with the advent of L-dopa therapy for PD in 1969 (5), all surgical options for these movement disorders declined in popularity. This process was accelerated by Hoehn and Yahr’ s longitudinal study in 1969 (6), in which they found that although up to 80% of patients may lose tremor and rigidity after a thalamotomy, because of persisting akinesia only 17% were functionally better.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Cooper, I. S. (1954) Intracerebral injection of procaine into the globus pallidus in hyperkinetic disorders. Science 119, 417–418.

    Article  PubMed  CAS  Google Scholar 

  2. Spiegel, E. A. and Wycis, H. T. (1954) Ansotomy in paralysis agitans. Arch. Neurol. Psychiatry 71, 598–614.

    CAS  Google Scholar 

  3. Reichert, T. (1962b) Long term follow up of results of stereotaxic treatment of extrapyramidal disorders. Confinia Neurol. 22, 356–363.

    Article  Google Scholar 

  4. Krayenbuhl, H. O., Wyss, O., et al. (1961) Bilateral thalamotomy and pallidotomy as treatment for bilateral parkinsonism. J. Neurosurg. 16, 429–444.

    Google Scholar 

  5. Cotzias, G., Papavasiliou, P., et al. (1969) Long term effects of DOPA on parkinsonism: a proposal. In: Third Symposium on Parkinson’s Disease. Livingstone, Edinburgh.

    Google Scholar 

  6. Hoehn, M. M. and Yahr, M. D. (1969) Evaluation of the long term results of surgical therapy. In: Third Symposium on Parkinson’s Disease Livingstone, Edinburgh, UK, pp. 274–280.

    Google Scholar 

  7. Poewe, W. H., Lees, A. J., and Stern, G. M. (1986) Low-dose L-dopa therapy in Parkinson’s disease: a 6-year followup study. Neurology 36, 1528–1530.

    Article  PubMed  CAS  Google Scholar 

  8. Davis, G. C., Williams, A. C., Markey, S. P., Ebert, M. H., Caine, E. D., Reichert, C. M., et al. (1979) Chronic Parkinsonism secondary to intravenous injection of meperidine analogues. Psychiatry Res. 1, 249–254.

    Article  PubMed  CAS  Google Scholar 

  9. Langston, J. W., Ballard, P., Tetrud, J. W., and Irwin, I. (1983) Chronic Parkinsonism in humans due to a product of meperidine-analog synthesis. Science 219, 979–980.

    Article  PubMed  CAS  Google Scholar 

  10. Forno, L. S., Langston, J. W., DeLanney, L. E., Irwin, I., and Ricaurte, G. A. (1986) Locus ceruleus lesions and eosinophilic inclusions in MPTP-treated monkeys. Ann. Neurol. 20, 449–455.

    Article  PubMed  CAS  Google Scholar 

  11. Bums, R. S., Chiueh, C. C., Markey, S. P., Ebert, M. H., Jacobowitz, D. M., and Kopin, I. J. (1983) A primate model of parkinsonism: selective destruction of dopaminergic neurons in the pars compacta of the substantia nigra by N-methyl4- phenyl-1,2,3,6-tetrahydropyridine. Proc. Natl. Acad. Sci. USA 80, 4546–4550.

    Article  Google Scholar 

  12. Delong, M. R., Georgopoulos, A. P., Crutcher, M. D., Mitchell, S. J., Richardson, R. T., and Alexander, G. E. (1984) Functional organization of the basal ganglia: contributions of single-cell recording studies. In: Functions of the Basal Ganglia (Evered, D. and O’Connor, M., eds.), Pitman, London, pp. 64–82.

    Google Scholar 

  13. DeLong, M. R. (1990) Primate models of movement disorders of basal ganglia origin. Trends Neurosci. 13, 281–285.

    Article  PubMed  CAS  Google Scholar 

  14. Filion, M. and Tremblay, L. (1991) Abnormal spontaneous activity of globus pallidus neurons in monkeys with MPTPinduced parkinsonism. Brain Res. 547, 142–151.

    PubMed  CAS  Google Scholar 

  15. Mitchell, I. J., Clarke, C. E., Boyce, S., Robertson, R. G., Peggs, D., Sambrook, M. A., et al. (1989) Neural mechanisms underlying parkinsonian symptoms based upon regional uptake of 2-deoxyglucose in monkeys exposed to 1-methyl4-phenyl- 1,2,3,6-tetrahydropyridine. Neuroscience 32, 213–226.

    Article  PubMed  CAS  Google Scholar 

  16. Bergman, H., Wichmann, T., and DeLong, M. R. (1990) Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science 249, 1436–1438.

    Article  PubMed  CAS  Google Scholar 

  17. Aziz, T. Z., Peggs, D., Sambrook, M. A., and Crossman, A. R. (1991) Lesion of the subthalamic nucleus for the alleviation of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism in the primate. Mov. Disord. 6, 288–292.

    Article  PubMed  CAS  Google Scholar 

  18. Benazzouz, A., Gross, C., Feger, J., Boraud, T., and Bioulac, B. (1993) Reversal of rigidity and improvement in motor performance by subthalamic high-frequency stimulation in MPTP-treated monkeys. Eur. J. Neurosci. 5, 382–389.

    Article  PubMed  CAS  Google Scholar 

  19. Sellal, F., Hirsch, E., Lisovoski, F., Mutschler, V., Collard, M., and Marescaux, C. (1992) Contralateral disappearance of parkinsonian signs after subthalamic hematoma. Neurology 42, 255–256.

    Article  PubMed  CAS  Google Scholar 

  20. Aziz, T. Z., Peggs, D., Agarwal, E., Sambrook, M. A., and Crossman, A. R. (1992) Subthalamic nucleotomy alleviates parkinsonism in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-exposed primate. Br. J. Neurosurg. 6, 575–582.

    Article  PubMed  CAS  Google Scholar 

  21. Robertson, R. G., Clarke, C. A., Boyce, S., Sambrook, M. A., and Crossman, A. R. (1990) The role of striatopallidal neurones utilizing gamma-aminobutyric acid in the pathophysiology of MPTP-induced parkinsonism in the primate: evidence from. Brain Res. 531, 95–104.

    Article  PubMed  CAS  Google Scholar 

  22. Laitinen, L. V., Bergenheim, A. T., and Hariz, M. I. (1992) Leksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease. J. Neurosurg. 76, 53–61.

    Article  PubMed  CAS  Google Scholar 

  23. Svennilson, E., Torvik, A., Lowe, R., and Leksell, L. (1960) Treatment of parkinsonism by stereotactic thermolesions in the pallidal region. Acta Psychiatr. Neurol. Scand. 35, 358–377.

    Article  CAS  Google Scholar 

  24. Sutton, J. P., Couldwell, W., Lew, M. F., Mallory, L., Grafton, S., DeGiorgio, C., et al. (1995) Ventroposterior medial pallidotomy in patients with advanced Parkinson’s disease. Neurosurgery 36, 1112–1116; discussion 1116–1117.

    Article  PubMed  CAS  Google Scholar 

  25. Iacono, R. P., Lonser, R. R., Oh, A., and Yamada, S. (1995) New pathophysiology of Parkinson’s disease revealed by posteroventral pallidotomy. Neurol. Res. 17, 178–180.

    PubMed  CAS  Google Scholar 

  26. Baron, M. S., Vitek, J. L., Bakay, R. A., Green, J., Kaneoke, Y., Hashimoto, T., et al. (1996) Treatment of advanced Parkinson’s disease by posterior GPi pallidotomy: 1-year results of a pilot study. Ann. Neurol. 40, 355–366.

    Article  PubMed  CAS  Google Scholar 

  27. Dalvi, A., Winfield, L., Yu, Q., Cote, L., Goodman, R. R., and Pullman, S. L. (1999) Stereotactic posteroventral pallidotomy: clinical methods and results at 1-year follow up. Mov. Disord. 14, 256–261.

    Article  PubMed  CAS  Google Scholar 

  28. de Bie, R. M., de Haan, R. J., Nijssen, P. C., Rutgers, A. W., Beute, G. N., Bosch, D. A., et al. (1999) Unilateral pallidotomy in Parkinson’s disease: a randomised, single-blind, multicentre trial. Lancet 354, 1665–1669.

    Google Scholar 

  29. Dogali, M., Fazzini, E., Kolodny, E., Eidelberg, D., Sterio, D., Devinsky, O., et al. (1995) Stereotactic ventral pallidotomy for Parkinson’s disease. Neurology 45, 753–761.

    Article  PubMed  CAS  Google Scholar 

  30. Giller, C. A., Dewey, R. B., Ginsburg, M. I., Mendelsohn, D. B., and Berk, A. M. (1998) Stereotactic pallidotomy and thalamotomy using individual variations of anatomic landmarks for localization. Neurosurgery 42, 56–62; discussion 62–65.

    Article  PubMed  CAS  Google Scholar 

  31. Lang, A. E., Lozano, A. M., Montgomery, E., Duff, J., Tasker, R., and Hutchinson, W. (1997) Posteroventral medial pallidotomy in advanced Parkinson’s disease. N. Engl. J. Med. 337, 1036–1042.

    Article  PubMed  CAS  Google Scholar 

  32. Shannon, K. M., Penn, R. D., Kroin, J. S., Adler, C. H., Janko, K. A., York, M., et al. (1998) Stereotactic pallidotomy for the treatment of Parkinson’s disease. Efficacy and adverse effects at 6 months in 26 patients. Neurology 50, 434–438.

    Article  PubMed  CAS  Google Scholar 

  33. Jankovic, J., Lai, E., Ben-Arie, L., Krauss, J. K., and Grossman, R. (1999) Levodopa-induced dyskinesias treated by pallidotomy. J. Neurol. Sci. 167, 62–67.

    Article  PubMed  CAS  Google Scholar 

  34. Ondo, W. G., Jankovic, J., Lai, E. C., Sankhla, C., Khan, M., Ben-Arie, L., et al. (1998) Assessment of motor function after stereotactic pallidotomy. Neurology 50, 266–270.

    Article  PubMed  CAS  Google Scholar 

  35. Samuel, M., Caputo, E., Brooks, D. J., Schrag, A., Scaravilli, T., Branston, N. M., et al. (1998) A study of medial pallidotomy for Parkinson’s disease: clinical outcome, MRI location and complications. Brain 121(Pt 1) , 59–75.

    Article  PubMed  Google Scholar 

  36. Uitti, R. J., Wharen, R. E. Jr., and Turk, M. F. (1998) Efficacy of levodopa therapy on motor function after posteroventral pallidotomy for Parkinson’s disease. Neurology 51, 1755–1757.

    Article  PubMed  CAS  Google Scholar 

  37. Alterman, R. L. and Kelly, P. J. (1998) Pallidotomy technique and results: the New York University experience. Neurosurg. Clin. North Am. 9, 337–343.

    CAS  Google Scholar 

  38. Pollak, P., Benabid, A. L., Gross, C., Gao, D. M., Laurent, A., Benazzouz, A., et al. (1993) [Effects of the stimulation of the subthalamic nucleus in Parkinson disease]. Rev. Neurol. (Paris) 149, 175–176.

    CAS  Google Scholar 

  39. Limousin, P., Krack, P., Pollak, P., Benazzouz, A., Ardouin, C., Hoffmann, D., et al. (1998) Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N. Engl. J. Med. 339, 1105–1111.

    Article  PubMed  CAS  Google Scholar 

  40. Alexander, E. III, Kooy, H. M., van Herk, M., Schwartz, M., Barnes, P. D., Tarbell, N., et al. (1995) Magnetic resonance image-directed stereotactic neurosurgery: use of image fusion with computerized tomography to enhance spatial accuracy. J. Neurosurg. 83, 271–276.

    Article  PubMed  Google Scholar 

  41. Kooy, H. M., van Herk, M., Barnes, P. D., Alexander, E. III, Dunbar, S. F., Tarbell, N. J., et al. (1994) Image fusion for stereotactic radiotherapy and radiosurgery treatment planning. Int. J. Radiat. Oncol. Biol. Phys. 28, 1229–1234.

    Article  PubMed  CAS  Google Scholar 

  42. Schaltenbrand, G. and Wahren, W. (eds.) (1977) Atlas for Stereotaxy of the Human Brain. Thieme, Stuttgart.

    Google Scholar 

  43. Aziz, T. Z. and Bain, P. G. (1996) A multidisciplinary approach to tremor. Br. J. Neurosurg. 10, 435–437.

    Article  PubMed  CAS  Google Scholar 

  44. Munro-Davies, L. E., Gregory, R., Squires, W., Radatz, M., Silburn, P., Scott, R., et al. (1999) Lateral pallidotomy exacerbates akinesia in the Parkinsonian patient. J. Clin. Neurosci. 6, 474–476.

    Article  PubMed  CAS  Google Scholar 

  45. Vitek, J., Bakay, R., and DeLong, M. (1997) Microelectrode-guided pallidotomy for medically intractable Parkinson’s disease. In: Advances in Neurology (Obeso, J., DeLong, M., Ohye, C., and Marsden, C. D., eds.), Lippincott-Raven, Philadelphia, PA, pp. 183–198.

    Google Scholar 

  46. Esklander, E. N., Cosgrove, G. R., Shinobu, L. A., and Penney, J. B. (1998) The importance of accurate lesion placement in posteroventral pallidotomy: report of two cases. J. Neurosurg. 89, 630–634.

    Article  Google Scholar 

  47. Bronte-Stewart, H. M., Hill, B., Molander, M. P., Kaufman, R. L., Pappas, C., Fross, R. D., and Klingman, J. (1998) Lesion location predicts clinical outcome of pallidotomy. Mov. Disord. 13(Suppl. 2) , 300.

    Google Scholar 

  48. Gibb, W. R. and Lees, A. J. (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J. Neurol. Neurosurg. Psychiatry 51, 745–752.

    Article  PubMed  CAS  Google Scholar 

  49. Scott, R., Gregory, R., Hines, N., Carroll, C., Hyman, N., Papanasstasiou, V., et al. (1998) Neuropsychological, neurological and functional outcome following pallidotomy for Parkinson’s disease. A consecutive series of eight simultaneous bilateral and twelve unilateral procedures. Brain 121(Pt 4) , 659–675.

    Article  PubMed  Google Scholar 

  50. Trepanier, L. L., Saint-Cyr, J. A., Lozano, A. M., and Lang, A. E. (1998) Neuropsychological consequences of posteroventral pallidotomy for the treatment of Parkinson’s disease. Neurology 51, 207–215.

    Article  PubMed  CAS  Google Scholar 

  51. Lozano, A. M., Kumar, R., Gross, R. E., Giladi, N., Hutchison, W. D., Dostrovsky, J. O., et al. (1997) Globus pallidus internus pallidotomy for generalized dystonia. Mov. Disord. 12, 865–870.

    Article  PubMed  CAS  Google Scholar 

  52. Luciana, M. and Nelson, C. A. (1998) The functional emergence of prefrontally-guided working memory systems in four- to eight-year-old children. Neuropsychologia 36, 273–293.

    Article  PubMed  CAS  Google Scholar 

  53. Kumar, R., Lozano, A. M., Kim, Y. J., Hutchison, W. D., Sime, E., Halket, E., et al. (1998) Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease. Neurology 51, 850–855.

    Article  PubMed  CAS  Google Scholar 

  54. Moro, E., Scerrati, M., Romito, L. M., Roselli, R., Tonali, P., and Albanese, A. (1999) Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson’s disease. Neurology 53, 85–90.

    Article  PubMed  CAS  Google Scholar 

  55. Volkmann, J., Sturm, V., Weiss, P., Kappler, J., Voges, J., Koulousakis, A., et al. (1998) Bilateral high-frequency stimulation of the internal globus pallidus in advanced Parkinson’s disease. Ann. Neurol. 44, 953–961.

    Article  PubMed  CAS  Google Scholar 

  56. Houeto, J. L., Damier, P., Bejjani, P. B., Staedler, C., Bonnet, A. M., Arnulf, I., et al. (2000) Subthalamic stimulation in Parkinson disease: a multidisciplinary approach. Arch. Neurol. 57, 461–465.

    Article  PubMed  CAS  Google Scholar 

  57. Carroll, C. B., Scott, R., Davies, L. E., and Aziz, T. (1998) The pallidotomy debate. Br. J. Neurosurg. 12, 146–150.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Simon Parkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carole Joint
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tipu Z. Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Daniel Tarsy MD

  2. Emory University School of Medicine, Atlanta, GA, USA

    Jerrold L. Vitek MD, PhD

  3. Toronto Western Hospital, Toronto, ON, Canada

    Andres M. Lozano MD, PhD

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Parkin, S., Joint, C., Scott, R., Aziz, T.Z. (2003). Bilateral Pallidotomy for Parkinson’s Disease. In: Tarsy, D., Vitek, J.L., Lozano, A.M. (eds) Surgical Treatment of Parkinson’s Disease and Other Movement Disorders. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-312-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-312-5_9

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4684-9736-6

  • Online ISBN: 978-1-59259-312-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation