Inhibition of levodopa effects by internal pallidal stimulation†
Corresponding Author
Paul Krack MD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Neurologische Klinik der Christian Albrechts Universität zu Kiel, Niemannsweg 147, 24105 Kiel, GermanySearch for more papers by this authorPierre Pollak MD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorPatricia Limousin MD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorDominique Hoffmann MD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorAbdelhamid Benazzouz PhD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorAlim-Louis Benabid MD, PhD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorCorresponding Author
Paul Krack MD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Neurologische Klinik der Christian Albrechts Universität zu Kiel, Niemannsweg 147, 24105 Kiel, GermanySearch for more papers by this authorPierre Pollak MD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorPatricia Limousin MD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorDominique Hoffmann MD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorAbdelhamid Benazzouz PhD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorAlim-Louis Benabid MD, PhD
Department of Clinical and Biological Neurosciences and INSERM U318, Joseph Fourier University of Grenoble, France
Search for more papers by this authorA videotape accompanies this article.
Abstract
We report three patients with bilateral GPi stimulation for stage 4 Parkinson's disease (PD) with severe levodopa-induced dyskinesias (LID). In all three it was possible to completely inhibit LID using high-stimulation parameters. Parallel to complete inhibition of LID, an inhibition of the anti-akinetic effect of levodopa was observed, whereas, at the same time, rigidity was markedly improved. GPi stimulation is adaptable over time, and stimulation parameters have to be programmed according to off-and on-period motor symptoms. The main interest of stimulation is the possibility of finding a compromise between LID alleviation in on-phase without loss of the beneficial motor effects and improvement in parkinsonism in off-phase. In some patients, residual dyskinesias have to be accepted so as not to aggravate on-period motor symptoms by a presumed overinhibition of basal ganglia outflow.
References
- 1 Benabid AL, Pollak P, Gervason C, et al. Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet 1991; 337: 403–406.
- 2 Limousin P, Pollak P, Benazzouz A, et al. Effect on parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 1995; 345: 91–95.
- 3 Siegfried J, Lippitz B. Bilateral chronic electrostimulation of ventroposterolateral pallidum: a new therapeutic approach for alleviating all parkinsonian symptoms. Neurosurgery 1994; 35: 1126–1130.
- 4 Pahwa R, Wilkinson S, Smith D, Lyons K, Miyawaki E, Koller WC. High-frequency stimulation of the globus pallidus for the treatment of Parkinson's disease. Neurology 1997; 49: 249–253.
- 5 Krack P, Pollak P, Limousin P, Benabid AL. Levodopa-inhibiting effect of pallidal surgery. Ann Neurol 1997; 42: 129.
- 6 Baron MS, Vitek JL, Bakay RAE, et al. Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study. Ann Neurol 1996; 40: 355–366.
- 7 Dogali M, Fazzini E, Kolodny E, et al. Stereotactic ventral pallidotomy for Parkinson's disease. Neurology 1995; 45: 753–761.
- 8 Lozano AM, Lang AE, Galvez-Jimenez N, et al. Effect of GPi pallidotomy on motor function in Parkinson's disease. Lancet 1995; 346: 1383–1387.
- 9 Kishore A, Turnbull IM, Snow BJ, et al. Efficacy, stability and predictors of outcome of pallidotomy for Parkinson's disease. Six-months follow-up with additional 1-year observations. Brain 1997; 120: 729–737.
- 10 Krack P, Pollak P, Limousin P, Benazzouz A, Benabid AL. Modifications of the stimulation site within GPi induce different motor effects in parkinsonian patients [Abstract]. Mov Disord 1997; 12(suppl 1): 84.
- 11 Krack P, Pollak P, Limousin P, et al. Opposite motor effects of pallidal stimulation in Parkinson's disease. Ann Neurol 1998; 43: 180–192.
- 12 Fahn S, Elton RL. Unified Parkinson's Disease Rating Scale. In: S Fahn, CD Marsden, D Calne, M Goldstein, eds. Recent Developments in Parkinson's Disease. Florham Park, NJ: Macmillan Health Care Information, 1987: 153–163.
- 13 Tronnier VM, Fogel W, Kronenbuerger M, Steinvorth S. Pallidal stimulation: an alternative to pallidotomy? Neurosurgery 1997; 87: 700–705.
- 14 Guiot G, Brion S. Traitement des mouvements anormaux par la coagulation pallidale. Technique et résultats. Rev Neurol 1952; 89: 578–580.
- 15 Schwab R, England A, Peterson E. Akinesia in Parkinson's disease. Neurology 1959; 9: 65–72.
- 16 Narabayashi H, Miyashita N, Hattori Y, Saito K, Endo K. Posteroventral pallidotomy: its effect on motor symptoms and scores of MMPI test in patients with Parkinson's disease. Parkinsonism and Related Disorders 1997; 3: 7–20.
- 17 Laitinen LV, Bergenheim AT, Hariz MI. Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 1992; 76: 53–61.
- 18 Obeso J, Linazasoro G, Rothwell J, Jahanshahi M, Brown R. Assessing the effects of pallidotomy in Parkinson's disease. Lancet 1996; 347i: 1490.
- 19 Lang AE, Lozano AM, Montgomery EB, Duff J, Tasker RR, Hutchison WD. Posteroventral medial pallidotomy in advanced Parkinson's disease. N Engl J Med 1997; 337: 1036–1042.
- 20 Verhagen L, Mouradian M, Chase T. Altered levodopa doseresponse profile following pallidotomy [Abstract]. Neurology 1996; 46: A416–A417.
- 21 Mink J, Thach W. Basal ganglia motor control. III. Pallidal ablation: normal reaction time, muscle co-contraction and slow movements. J Neurophysiol 1991; 65: 330–351.
- 22 Bhatia KP, Marsden CD. The behavioral and motor consequences of focal lesions of the basal ganglia in man. Brain 1994; 117: 859–876.
- 23 Marsden CD, Obeso JA. The functions of the basal ganglia and the paradox of stereotactic surgery in Parkinson's disease. Brain 1994; 117: 877–897.
- 24 Lawrence DG, Kuypers HGJM. The functional organization of the motor system in monkey. II. The effects of lesions of the descending brainstem pathways. Brain 1968; 91: 15–36.
- 25 Crossman AR, Sambrook MA, Gergies SW, Slater P. The neurological basis of motor asymmetry following unilateral 6-hydroxydopamine brain lesions in the rat: the effect of motor decortication. J Neurol Sci 1977; 34: 407–414.
- 26 Fève AP, Fénelon G, Wallays C, Rémy P, Guillard A. Axial motor disturbances after hypoxic lesions of the globus pallidus. Mov Disord 1993; 8: 321–326.
- 27 Krack P, Pollak P, Limousin P, et al. Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson's disease. Brain 1998; 121: 451–457.
- 28 Krack P, Limousin P, Benabid AL, Pollak P. Chronic stimulation of subthalamic nucleus improves levodopa-induced dyskinesias in Parkinson's disease. Lancet 1997; 350: 1676.
- 29 Krack P, Pollak P, Limousin P, Benazzouz A, Benabid AL. Stimulation of subthalamic nucleus alleviates tremor in Parkinson's disease. Lancet 1997; 350: 1675.
