[Roles of the basal ganglia outputs in movement disorders: a viewpoint based on experiences of stereotactic surgery for idiopathic dystonia].
Ventrolateral (VL)-thalamotomy and posteroventral pallidotomy were carried out in 37 patients with idiopathic dystonia, including 23 with dystonia musculorum deformans, 12 with Meige syndrome and 2 with focal dystonia. There were 11 patients with the onset age of dystonia below 10 years and 26 with the age above 11 years. Dystonia tended to generalize in the pediatric patients and to localize to the palmo-mental region in the adult patients. VL-thalamotomy in 30 patients improved the upper body dystonia especially in the adult patients, but, often failed to benefit the pediatric patients. Posteroventral pallidotomy in 18 patients dramatically alleviated the generalized dystonia especially in the pediatric patients. In one adult patient, pallidotomy caused hemiparesis due to intracerebral hemorrhage. The internal pallidum projects the efferents to the thalamic motor nuclei and also to the brainstem reticular formation that connects to the spinal motoneurons. The present findings implicate the descending pallido-reticular pathway in the mechanism of dystonia of pediatric patients, and the ascending pallido-thalamic pathway in that of adult patients.
Shima
F
F
Department of Clinical Neurophysiology, Kyushu University, Fukuoka.
Ishido
K
K
Kato
M
M
D000293:Adolescent; D000328:Adult; D000344:Afferent Pathways / Q000502:physiology; D000367:Age Factors; D000368:Aged; D001479:Basal Ganglia / Q000503:physiopathology*; D002648:Child; D004421:Dystonia / Q000503:physiopathology* / Q000601:surgery*; D004525:Efferent Pathways / Q000502:physiology; D005260:Female; D005917:Globus Pallidus / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000601:surgery