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Role of stereotaxic surgery in treatment of Parkinson’s disease

  • H. Narabayashi
Part of the Key Topics in Brain Research book series (KEYTOPICS)

Summary

Rigidity and tremor are almost completely alleviated by stereotaxic surgery on the ventral subnuclei of the thalamus without producing side effect. With use of microelectrode technique to analyze the neuronal activity, the VL, which receives the pallidal afferents, is explained responsible for rigidity and the Vim, which receives the proprioceptive afferents from periphery, for tremor. Primary akinesia is not changed at all by surgery but responds well to levodopa. Long-term observations of the postoperative course established that improvement by surgery with/without medicine was more sustained and longlasting in the cases of younger onset than in those of classical PD. This may suggest that in clinical and pathophysiological analysis, the degenerative process of the disease is limited within the nigrostriatal DA system in the former and more widespread in the latter. Within the nigrostriatum, nigroputaminal part is analysed to be first affected. Speed of progression seems to show the difference between cases of early onset parkinsonism and PD.

Keywords

Compact Zone Early Onset Parkinsonism Stereotaxic Surgery Proprioceptive Afferents Human Thalamus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Albe-Fessard D, Arfel G, Guiot G (1963) Activités électriques caractéristiques de quelques structures cérébrales chez l’homme. Ann Chir 17: 1185–1214PubMedGoogle Scholar
  2. Fukamachi A, Ohye Ch, Narabayashi H (1973) Delineation of the thalamic nuclei with a microelectrode in stereotaxic surgery for parkinsonism and cerebral palsy. J Neurosurg 39: 214–225PubMedCrossRefGoogle Scholar
  3. Fukamachi A, Ohye Ch, Saito Y, Narabayashi H (1977) Estimation of the neural noise within the human thalamus. Acta Neurochir (Wien) [Suppl 24]: 121–136Google Scholar
  4. Gibb WRG, Narabayashi H, Yokochi M, Iizuka R, Lees AJ (1991) New pathological observations in juvenile onset parkinsonism with dystonia (dopa-responsive dystonia). Neurology (in press)Google Scholar
  5. Goto S, Hirano A, Matsumoto S (1989) Subdivisional involvement of nigrostriatal loop in idiopathic Parkinson’s disease and striatonigral degeneration. Ann Neurol 26: 766–770PubMedCrossRefGoogle Scholar
  6. Graybiel AM, Ragsdale CW (1983) Biochemical anatomy of the striatum. In: Emson PC (ed) Chemical neuroanatomy. Raven Press, New York, pp 427–504Google Scholar
  7. Narabayashi H, Okuma T, Shikiba S (1956) Procaine oil blocking of the globus pallidus. Arch Neurol Psychiat 75: 36–48Google Scholar
  8. Narabayashi H, Ohye C (1978) Parkinsonian tremor and nucleus ventralis intermedius of the human thalamus. In: Desmedt JE (ed) Physiological tremor, pathological tremors and clonus. Karger, Basel, pp 165–172 (Prog Clin Neurophysiol, vol 5 )Google Scholar
  9. Narabayashi H (1980) Clinical analysis of akinesia. J Neural Transm [Suppl 16]: 129–136Google Scholar
  10. Narabayashi H, Kondo T, Hayashi A, Suzuki T, Nagatsu T (1981) L-threo-3, 4-dihydroxyphenylserine treatment for akinesia and freezing of parkinsonism. Proc Japan Acad 57 (Ser B): 351–354Google Scholar
  11. Narabayashi H (1983) Pharmacological basis of akinesia in Parkinson’s disease. J Neural Transm [Suppl 19]: 143–151Google Scholar
  12. Narabayashi H, Yokochi F, Nakajima Y (1984) Levodopa-induced dyskinesia and thalamotomy. J Neurol Neurosurg Psychiatry 47: 831–839PubMedCrossRefGoogle Scholar
  13. Narabayashi H (1986) Tremor: its generating mechanism and treatment. In: Vinken PJ, Bruyn GW, Klawans HL (eds) Handbook of clinical neurology, vol 5 (49)- Elsevier Science Publishers, Amsterdam, pp 597–607Google Scholar
  14. Narabayashi H, Yokochi M, Iizuka R, Nagatsu T (1986a) Juvenile parkinsonism. In: Vinken PJ, Bruyn GW, Klawans HL (eds) Handbook of clinical neurology, vol 5 (49). Elsevier Science Publishers, Amsterdam, pp 153–165Google Scholar
  15. Narabayashi H, Kondo T, Yokochi F, Nagatsu T (1986b) Clinical effects of L-threo-3, 4-dihydroxyphenylserine in cases of parkinsonism and pure akinesia. In: Yahr MD, Bergmann KJ (eds) Advances in neurology, vol 45. Raven Press, New York, pp 593–602Google Scholar
  16. Narabayashi H, Kondo T (1987) Results of a double-blind study of L-threo-DOPS in parkinsonism. In: Fahn S, Marsden CD, Calne D, Goldstein M (eds) Recent developments in Parkinson’s disease, vol 2. Macmillan, New Jersey, pp 279–291Google Scholar
  17. Narabayashi H (1988) Lessons from stereotaxic surgery using microelectrode techniques in understanding parkinsonism. Mt Sinai J Med 55: 50–57PubMedGoogle Scholar
  18. Narabayashi H (1990a) Surgical treatment in the levodopa era. In: Stern G (ed) Parkinson’s disease. Chapman & Hall, London, pp 597–646Google Scholar
  19. Narabayashi H (1990b) Clinical analysis of juvenile and classical parkinsonism and underlying pathophysiological mechanisms. Presented at the Xlth International Congress of Neuropathology, Kyoto, 1990Google Scholar
  20. Ohye Ch, Saito Y, Fukamachi A, Narabayashi H (1974) An analysis of the spontaneous rhythmic and non-rhythmic burst discharges in the human thalamus. J Neurol Sci 22: 245–259PubMedCrossRefGoogle Scholar
  21. Ohye Ch, Maeda T, Narabayashi H (1976/77) Physiologically defined VIM nucleus. Appl Neurophysiol 39: 285–295Google Scholar
  22. Ohye C (1982) Depth microelectrode studies. In: Schaltenbrand G, Walker AE (eds) Stereotaxy of the human brain. G Thieme, Stuttgart New York, pp 372–389Google Scholar
  23. Schaltenbrand G, Bailey P (1959) Introduction to stereotaxis with atlas of human brain. G Thieme, Stuttgart New YorkGoogle Scholar
  24. Schaltenbrand G, Walker AE (eds) (1982) Stereotaxy of the human brain, 2nd ed. G Thieme, Stuttgart New YorkGoogle Scholar
  25. Yoshida M, Yanagisawa N, Shimazu H, Givre A, Narabayashi H (1964) Physiological identification of the thalamic nucleus. Arch Neurol 11: 434–443CrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1991

Authors and Affiliations

  • H. Narabayashi
    • 1
  1. 1.Juntendo UniversityTokyoJapan

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