Multi-target strategy for Parkinsonian patients: the role of deep brain stimulation in the centromedian-parafascicularis complex.
The intra-laminar (IL) thalamic complex, composed of centromedian (CM) and parafascicular (Pf) nucleus, is a strategic crossroad for the activity of the basal ganglia and is recently regaining its position has a putative neurosurgical target for Parkinsonian syndromes. The multi-target approach we have encouraged since the late nineties has allowed the combined implantation of a standard target (the subthalamic nucleus-STN or the internal pallidus-GPi) plus an innovative one (CM/Pf) in well-identified Parkinson's disease (PD) patients; hence, it is possible to study, in the same PD patients, the specific target-mediated effects on different clinical signs. Here, we focus on the potential usefulness of implanting the CM/Pf complex when required in the management of contra-lateral tremor (resistant to standard deep brain stimulation-DBS - in STN - , n=2) and disabling involuntary movements, partially responsive to GPi-DBS (n=6). When considering global UPDRS scores, CM/Pf-DBS ameliorate extra-pyramidal symptoms but not as strongly as STN (or GPi) does. Yet, CM/Pf acts very powerfully on tremor and contributes to the long-term management of l-Dopa-induced involuntary movements. The lack of cognitive deficits and psychic impairment associated with the improvement of their quality of life, in our small cohort of CM/Pf implanted patients, reinforces the notion of CM/Pf as a safe and attractive area for surgical treatment of advanced PD, possibly affecting not only motor but also associative functions.
Stefani
Alessandro
A
IRCCS Fondazione S. Lucia, Roma, Italy. stefani@uniroma2.it
Peppe
Antonella
A
Pierantozzi
Mariangela
M
Galati
Salvatore
S
Moschella
Vincenzo
V
Stanzione
Paolo
P
Mazzone
Paolo
P
D001479:Basal Ganglia / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000379:methods*; D020820:Dyskinesias / Q000209:etiology / Q000601:surgery / Q000628:therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D020646:Intralaminar Thalamic Nuclei / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D010300:Parkinson Disease / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome; D014202:Tremor / Q000209:etiology / Q000601:surgery / Q000628:therapy