| Electrical stimulation of the prelemniscal radiation in the treatment of Parkinson's disease: an old target revised with new techniques. | |
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MedLine Citation:
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PMID: 11504105 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: In the treatment of tremor and rigidity in patients with Parkinson's disease (PD), the prelemniscal radiation (RAPRL), a subthalamic bundle of fibers, is an exquisite target that can be visualized easily on ventriculograms. We sought to evaluate the effect of electrical stimulation of the RAPRL on symptoms and signs of PD in a long-term trial and to determine the localization of the stimulated area by means of stereotactic magnetic resonance imaging studies. METHODS: Ten patients with PD predominantly on one side had tetrapolar electrodes stereotactically oriented through a frontal parasagittal approach to the RAPRL contralateral to the most prominent symptoms. Preoperative and postoperative evaluations at 3, 6, 9, and 12 months after surgery were performed using conventional PD scales and quantitative evaluations of tremor amplitude and reaction time. Stereotactic high-resolution magnetic resonance imaging studies with the electrodes in place were used for anatomic localization. RESULTS: In all patients, temporary suppression of tremor occurred when the electrodes reached the target. The most effective stimulation was obtained when the pair of contacts was placed in the RAPRL. Long-term stimulation at 130 Hz, 0.09 to 0.450 milliseconds, and 1.5 to 3.0 V produced significant improvement in tremor and rigidity and mild improvement in bradykinesia. CONCLUSION: The RAPRL is an effective target for the alleviation of tremor and rigidity in patients with PD by either lesioning or neuromodulation; however, neuromodulation has the advantage of not inducing an increase in bradykinesia. The stimulated area seems to be independent of the subthalamic nucleus. |
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Authors:
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F Velasco; F Jiménez; M L Pérez; J D Carrillo-Ruiz; A L Velasco; J Ceballos; M Velasco |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 49 ISSN: 0148-396X ISO Abbreviation: Neurosurgery Publication Date: 2001 Aug |
Date Detail:
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Created Date: 2001-08-15 Completed Date: 2001-12-28 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: 293-306; discussion 306-8 Citation Subset: IM |
Affiliation:
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Stereotactic and Functional Neurosurgery Unit, General Hospital of Mexico, National Medical Center IMSS, Mexico City. fvelazco@netservice.com.mx |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Electric Stimulation Therapy* / adverse effects Female Humans Magnetic Resonance Imaging Male Middle Aged Parkinson Disease / diagnosis, physiopathology*, therapy* Stereotaxic Techniques Subthalamic Nucleus / pathology, physiopathology* Time Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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