Comparative evaluation of the effects of unilateral lesion versus electrical stimulation of the globus pallidus internus in advanced Parkinson's disease.
OBJECTIVE
To perform a prospective analysis on the effects of unilateral lesion versus unilateral electrical stimulation (ES) of the globus pallidus internus (Gpi) in the treatment of bilateral Parkinson's disease (PD).


METHODS
We studied 18 patients with stages III-V on the Hoehn and Yahr (H-Y) scale having prominent rigidity, bradykinesia and gait disturbances. Nine patients were treated with lesions and 9 patients with ES. Both groups were evaluated using the New York Parkinson's Disease Scale, the Unified Parkinson's Disease Rating Scale part III, and the H-Y scale and with specific items of tremor, rigidity and bradykinesia independently on each side. Both lesions and electrodes for ES were placed stereotactically in the Gpi as confirmed by postoperative magnetic resonance images. Significance of changes was evaluated with the Wilcoxon test after 3 and 6 months. Significance of intergroup differences was evaluated using the Mann-Whitney U test.


RESULTS
Lesions and ES significantly decreased rigidity (p < 0.01) and bradykinesia (p < 0.005) in the contralateral extremities. ES significantly decreased tremor in the contralateral extremities (p < 0.01) and rigidity and bradykinesia ipsilaterally (p < 0.01) at 3 months. There were no significant intergroup differences. The H-Y scale score showed improvement in self-sufficiency. L-DOPA dose was decreased by 31%.


CONCLUSIONS
ES was a safer procedure and more efficient in controlling PD symptoms. Unilateral lesions and ES may improve bilateral symptoms to the point of making patients self-sufficient.
Jiménez
Fiacro
F
Unit of Stereotactic, Functional Neurosurgery and Radiosurgery, Hospital General de México, Mexico City, Mexico. fiarcoj@yahoo.com
Velasco
Francisco
F
Carrillo-Ruiz
José D
JD
García
Luis
L
Madrigal
Adrián
A
Velasco
Ana Luisa
AL
Márquez
Irma
I
D000978:Antiparkinson Agents / Q000627:therapeutic use; D001931:Brain Mapping; D046690:Deep Brain Stimulation; D007839:Functional Laterality; D005917:Globus Pallidus / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D016343:Monitoring, Intraoperative; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa