Neuropsychological outcome of GPi pallidotomy and GPi or STN deep brain stimulation in Parkinson's disease.
This paper highlights the neuropsychological sequelae of posteroventral pallidotomy (PVP) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the internal segment of the globus pallidus (GPi) at 3/6 months postoperatively. Results are based on our extensive experience with PVP and our preliminary observations with DBS. Patients with borderline cognitive or psychiatric functioning risk postoperative decompensation. Nonlateralizing attentional and hemisphere-specific impairments of frontostriatal cognitive functions followed unilateral PVP. "Frontal" behavioral dyscontrol was observed in approximately 25% of patients. Three cases of staged bilateral PVP suggest that premorbid factors may predict outcome, although lesion size and location are also critical. Older patients are at risk for significant cognitive and behavioral decline after bilateral STN DBS, while GPi DBS may be safer.
Trépanier
L L
LL
Toronto Western Hospital--Research Institute, University of Toronto and The Toronto Hospital, Ontario, Canada. lisa@playfair.utoronto.ca
Kumar
R
R
Lozano
A M
AM
Lang
A E
AE
Saint-Cyr
J A
JA
D000328:Adult; D000368:Aged; D001479:Basal Ganglia / Q000187:drug effects / Q000473:pathology; D001921:Brain / Q000473:pathology / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D004409:Dyskinesia, Drug-Induced / Q000209:etiology; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D005917:Globus Pallidus / Q000502:physiology* / Q000601:surgery*; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D010300:Parkinson Disease / Q000523:psychology / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care; D020531:Subthalamic Nucleus / Q000502:physiology*; D011795:Surveys and Questionnaires
D007980:Levodopa