| Autor: |
Benabid, A. L., Mitrofanis, J., Chabardes, S., Seigneuret, E., Torres, N., Piallat, B., Benazzouz, A., Fraix, V., Krack, P., Pollak, P., Grand, S., LeBas, J. F. |
| Zdroj: |
Textbook of Stereotactic & Functional Neurosurgery; 2009, p1603-1630, 28p |
| Abstrakt: |
The discovery in 1987 of the effects of stimulation at high-frequency able to mimic in a reversible and adjustable manner the effects of local destruction of functional targets has revived the functional neurosurgery of movement disorders, and currently other fields of functional neurosurgery such as psychosurgery. VIM thalamotomy allowed demonstrating the main properties of high frequency stimulation on the most spectacular symptom of Parkinson disease, which is tremor. However, the therapeutic effect was quickly clearly recognized as almost strictly limited to the alleviation of tremor and had no effect on bradykinesia and rigidity. The fact is that, although it is the most visible of these symptoms, tremor is not the most disabling: the difficulties of advanced parkinsonian patients are essentially related to akinesia and rigidity. The publication in 1990 by the groups of Mahlon DeLong [1] and of Crossman [2] of the prominent role of the subthalamic nucleus (STN) in the control of motor function and of its importance when destroyed to improve akinetic and rigidity symptoms in MPTP monkeys has opened new horizons for deep brain stimulation (DBS) in movement disorders. However, due to its reputation as the source of hemiballism when destroyed by hemorrhages, the STN did not appear to be a very attractive surgical target [3]. For this reason, subthalamotomy was not a good procedure to exploit this basic science discovery, the experience acquired during high-frequency stimulation (HFS) of the thalamus suggested that STN could be a target for neuroinhibition methods as provided by DBS. This assumption was supported by the results of experiments in MPTP monkeys replicating the conclusions of Bergmann΄s and Aziz΄s reports using HFS instead of lesioning [4]. The ultimate confirmation of the interests of this target was given when the first patients with advanced Parkinson΄s disease were implanted, showing that tremor, rigidity, and bradykinesia were very significantly improved by this method [5,6], allowing to decrease the drug dosage by 60% in average [7], and therefore alleviating the levodopa induced motor fluctuations and dyskinesias [8]. Since that time, this has been used all over the world and several thousands of patients have been operated and improved, making this method the reference surgical procedure for advanced Parkinson΄s disease. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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