My question is to J.A.
Obeso, M.D., C.W. Olanow, M.D., M.C. Rodriguez-Oroz, M.D., P. Krack,
M.D.,Is there any experience in doing a DBS of the STN  on someone who
previously underwentb a bilateral pallidotpmy
At 03:39 AM 9/27/2001 +0200, you wrote:
>Source:    NEJM, Volume 345:956-963 (2001, Number 13)
>Date:        September 27, 2001
>
>http://content.nejm.org/cgi/content/short/345/13/956?query=TOC
>
>Deep-Brain Stimulation of the Subthalamic Nucleus or the Pars Interna of the
>Globus Pallidus in Parkinson's Disease
>
>The Deep-Brain Stimulation for Parkinson's Disease Study Group
>The preparation of this article was overseen by the writing committee (J.A.
>Obeso, M.D., C.W. Olanow, M.D., M.C. Rodriguez-Oroz, M.D., P. Krack, M.D.,
>R. Kumar, M.D., and A.E. Lang, M.D.), who assume responsibility for the
>overall content and integrity of the manuscript.
>
>ABSTRACT
>
>Background
>Increased neuronal activity in the subthalamic nucleus and the pars interna
>of the globus pallidus is thought to account for motor dysfunction in
>patients with Parkinson's disease. Although creating lesions in these
>structures improves motor function in monkeys with induced parkinsonism and
>patients with Parkinson's disease, such lesions are associated with
>neurologic deficits, particularly when they are created bilaterally.
>Deep-brain stimulation simulates the effects of a lesion without destroying
>brain tissue.
>
>Methods
>We performed a prospective, double-blind, crossover study in patients with
>advanced Parkinson's disease, in whom electrodes were implanted in the
>subthalamic nucleus or pars interna of the globus pallidus and who then
>underwent bilateral high-frequency deep-brain stimulation. We compared
>scores on the motor portion of the Unified Parkinson's Disease Rating Scale
>when the stimulation was randomly assigned to be turned on or off. We
>performed unblinded evaluations of motor function preoperatively and one,
>three, and six months postoperatively.
>
>Results
>Electrodes were implanted bilaterally in 96 patients in the
>subthalamic-nucleus group and 38 patients in the globus-pallidus group.
>Three months after the procedures were performed, double-blind, crossover
>evaluations demonstrated that stimulation of the subthalamic nucleus was
>associated with a median improvement in the motor score (as compared with no
>stimulation) of 49 percent, and stimulation of the pars interna of the
>globus pallidus with a median improvement of 37 percent (P<0.001 for both
>comparisons). Between the preoperative and six-month visits, the percentage
>of time during the day that patients had good mobility without involuntary
>movements increased from 27 percent to 74 percent (P<0.001) with subthalamic
>stimulation and from 28 percent to 64 percent (P<0.001) with pallidal
>stimulation. Adverse events included intracranial hemorrhage in seven
>patients and infection necessitating removal of the leads in two.
>
>Conclusions
>Bilateral stimulation of the subthalamic nucleus or pars interna of the
>globus pallidus is associated with significant improvement in motor function
>in patients with Parkinson's disease whose condition cannot be further
>improved with medical therapy.
>
>----------------------------------------------------------------------
>To sign-off Parkinsn send a message to: mailto:[log in to unmask]
>In the body of the message put: signoff parkinsn

----------------------------------------------------------------------
To sign-off Parkinsn send a message to: mailto:[log in to unmask]
In the body of the message put: signoff parkinsn