Deep brain stimulation in Parkinson's disease: bilateral implantation of globus pallidus and subthalamic nucleus.
OBJECTIVE
Deep brain stimulation (DBS) of subthalamic nucleus (STN) and of the pars interna of globus pallidus (GPi) is used to improve Parkinsonian symptoms and attenuate levodopa-induced motor complications in Parkinson's disease (PD). What are the physiological effect of DBS and the best anatomical structure to stimulate are still not completely clear. In this way we could evaluate the clinical effects of simultaneous stimulation of STN and GPi as well as the isolated stimulation of each target.


METHODS
The stereotactic methods used to localise STN and GPi were based on non-telemetric ventriculography, with 3P Maranello or Leksell Stereotactic System. The effects of DBS have been assessed in 13 cases of PD, immediately after (30 minutes) the stimulation has turned on and during chronic stimulation (weeks or months).


RESULTS
Most of the studies have been conducted on patients with STN implantation, and these studies reported relevant improvement in motor function and relatively low rate of complication.


CONCLUSIONS
The large experience of ablative surgery associate with the DBS experience of some group worldwide indicate that GPi is a possible and very promising target for the management of Parkinsonian symptoms. Our patients demonstrate in acute and chronic evaluation, the best clinical results with contemporary activation of DBS in both targets.
Mazzone
P
P
Unit of Functional and Stereotactic Neurosurgery, CTO Hospital, Rome, Italy. steromaz@libero.it
D000978:Antiparkinson Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation; D004567:Electrodes, Implanted; D005260:Female; D005917:Globus Pallidus / Q000503:physiopathology; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa