title: Unilateral Stimulation of Prelemniscal Radiations for the Treatment of Acral Symptoms of Parkinson's Disease: Long-Term Results.
abstract: BACKGROUND
  Prelemniscal radiations (Raprl) have been proposed as a target for the treatment of Parkinson's disease. We evaluated effectiveness of this target through UPDRS-III in patients treated with Raprl deep brain stimulation (Raprl-DBS) and followed from 24 to 48 months.
  
  
  METHODS
  Nineteen patients in Hoehn-Yahr stages II-III were implanted with tetrapolar deep brain stimulation electrodes in Raprl contralateral to the extremities with more prominent symptoms. Placement was assisted by MRI/CT/anatomical atlas fusion, microelectrode recording, and micro- and macro-stimulation. The effect on motor symptoms was evaluated in an open label protocol through specific items of the UPDRS-III score, applied pre-operatively and 6, 12, 24, and 48 months after the onset of stimulation in an OFF-medication/ON-stimulation condition. Changes in scores with regard to pre-operative condition were obtained for each symptom in both sides and statistical significance determined through double-tail Wilcoxon test. Influence of demographic variables on outcome was analyzed using linear regression testing.
  
  
  RESULTS
  A greater than 80% decrease in UPDRS score for contralateral symptoms (classified as excellent results) occurred in 14 patients (73.7%), while in the other 5 it decreased from 33 to 79% (considered suboptimal results). These changes remained statistically significant up to 48 months (p < 0.01), while ipsilateral symptoms progressively increased. Suboptimal results were associated with selective improvement of only one symptom.
  
  
  CONCLUSIONS
  Raprl-DBS induces a long-term, significant improvement of contralateral acral symptoms of Parkinson's disease.
authors.affiliation: Unit for Stereotactic and Functional Neurosurgery and Radiosurgery, Mexico General Hospital, Mexico, D.F., Mexico.
authors.forename: Francisco
authors.initials: F
authors.lastname: Velasco
authors.affiliation: Unit for Stereotactic and Functional Neurosurgery and Radiosurgery, Mexico General Hospital, Mexico, D.F., Mexico.
authors.forename: José D
authors.initials: JD
authors.lastname: Carrillo-Ruiz
authors.affiliation: Unit for Stereotactic and Functional Neurosurgery and Radiosurgery, Mexico General Hospital, Mexico, D.F., Mexico.
authors.forename: Víctor
authors.initials: V
authors.lastname: Salcido
authors.affiliation: Unit for Stereotactic and Functional Neurosurgery and Radiosurgery, Mexico General Hospital, Mexico, D.F., Mexico.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Castro
authors.affiliation: Unit for Stereotactic and Functional Neurosurgery and Radiosurgery, Mexico General Hospital, Mexico, D.F., Mexico.
authors.forename: Julián
authors.initials: J
authors.lastname: Soto
authors.affiliation: Unit for Stereotactic and Functional Neurosurgery and Radiosurgery, Mexico General Hospital, Mexico, D.F., Mexico.
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Velasco
mesh_terms: D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Parkinson's disease; bradykinesia, electrical stimulation; prelemniscal radiations; rigidity; tremor