What can man do without basal ganglia motor output? The effect of combined unilateral subthalamotomy and pallidotomy in a patient with Parkinson's disease.
We have studied motor performance in a man with Parkinson's disease (PD) in whom thermolytic lesions of the left subthalamic and left globus pallidus nuclei interrupted the basal ganglia (BG)-thalamo-cortical motor circuit in the left hemisphere. This allowed us to study remaining motor capabilities in the absence of aberrant BG activity typical of PD. Movements of the left arm were slow and parkinsonian whereas movement speed and simple reaction times (RT) of the right (operated) arm were within the normal range with no obvious deficits in a range of daily life activities. Two main abnormalities were found with the right hand. (a) Implicit sequence learning in a probabilistic serial reaction time task was absent. (b) In a go/no-go task when the percent of no-go trials increased, the RT superiority with the right hand was lost. These deficits are best explained by a failure of the cortex, deprived of BG input, to facilitate responses in a probabilistic context. Our findings confirm the idea that it is better to stop BG activity than allowing faulty activity to disrupt the motor system but dispute earlier claims that interrupting BG output in PD goes without an apparent deficit. From a practical viewpoint, our observations indicate that the risk of persistent dyskinesias need not be viewed as a contraindication to subthalamotomy in PD patients since they can be eliminated if necessary by a subsequent pallidotomy without producing deficits that impair activities of daily life.
Obeso
J A
JA
Department of Neurology, Clínica Universitaria and Medical School of Navarra, Neuroscience Centre, CIMA, University of Navarra, Spain. jobeso@unav.es
Jahanshahi
M
M
Alvarez
L
L
Macias
R
R
Pedroso
I
I
Wilkinson
L
L
Pavon
N
N
Day
B
B
Pinto
S
S
Rodríguez-Oroz
M C
MC
Tejeiro
J
J
Artieda
J
J
Talelli
P
P
Swayne
O
O
Rodríguez
R
R
Bhatia
K
K
Rodriguez-Diaz
M
M
Lopez
G
G
Guridi
J
J
Rothwell
J C
JC
D000368:Aged; D001479:Basal Ganglia / Q000502:physiology*; D001696:Biomechanical Phenomena; D056344:Executive Function / Q000502:physiology; D019788:Fluorodeoxyglucose F18; D007839:Functional Laterality / Q000502:physiology; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D007858:Learning / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000502:physiology; D019635:Neurosurgical Procedures; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011187:Posture; D011597:Psychomotor Performance / Q000502:physiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D011930:Reaction Time / Q000502:physiology; D020531:Subthalamic Nucleus / Q000601:surgery*; D013998:Time Perception / Q000502:physiology; D050781:Transcranial Magnetic Stimulation
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18