Stephen Tatter, MGH Neurosurgery" <[log in to unmask]>
provides Current Bibliographies on Pallidotomy at the Mass General Hospital
World Wide Web site.
 
The address is http://neurosurgery.mgh.harvard.edu/fnctnlhp.htm
(The PD information is at the bottom).
 
For those with E-Mail access only, I have "borrowed" that information for your
benefit.
 
Pallidotomy Bibliography
 
09136035 95066035
Aminoff MJ
Treatment of Parkinson's disease.
Department of Neurology, University of California, San Francisco, School of
 Medicine 94143-0114.
West J Med (UNITED STATES) Sep 1994, 161 (3) p303-8
 
Pharmacotherapy with levodopa for Parkinson's disease provides symptomatic
 benefit, but
fluctuations in (or loss of) response may eventually occur. Dopamine agonists
 are also helpful and,
when taken with low doses of levodopa, often provide sustained benefit with
 fewer side effects;
novel agonists and new methods for their administration are therefore under
 study. Other
therapeutic strategies are being explored, including the use of type B monoamine
 oxidase
inhibitors to reduce the metabolic breakdown of dopamine,
 catechol-O-methyltransferase
inhibitors to retard the breakdown of levodopa, norepinephrine precursors to
 compensate for
deficiency of this neurotransmitter, glutamate antagonists to counteract the
 effects of the
subthalamic nucleus, and various neurotrophic factors to influence dopaminergic
 nigrostriatal cells.
Surgical procedures involving pallidotomy are sometimes helpful. Those involving
 cerebral
transplantation of adrenal medullary or fetal mesencephalic tissue have yielded
 mixed results;
benefits may relate to the presence of growth factors in the transplanted
 tissue. The
transplantation of genetically engineered cell lines will probably become the
 optimal
transplantation procedure. The cause of Parkinson's disease may relate to
 oxidant stress and the
generation of free radicals. It is not clear whether treatment with selegiline
 hydrochloride (a type
B monoamine oxidase inhibitor) delays the progression of Parkinson's disease,
 because the drug
also exerts a mild symptomatic effect. Daily treatment with vitamin E (a
 scavenger of free
radicals) does not influence disease progression, perhaps because of limited
 penetration into the
brain. (57 Refs.)
 
09109958 95039958
Klockgether T; Loschmann PA; Wullner U
New medical and surgical treatments for Parkinson's disease.
University of Tubingen, Germany.
Curr Opin Neurol (UNITED STATES) Aug 1994, 7 (4) p346-52,
 
This article reviews new medical and surgical treatments for Parkinson's disease
 (PD).
Catechol-O-methyl-transferase (COMT) inhibitors supplement the variety of
 antiparkinsonian
drugs interacting with the dopaminergic system. Clinical studies show that COMT
 inhibitors
prolong the action of levodopa in patients with the "wearing off" phenomenon.
 The atypical
antipsychotic drug clozapine is the treatment of choice for the alleviation of
 levodopa-induced
psychosis. Clozapine also has beneficial effects on tremor and levodopa-induced
 dyskinesias.
Thus, COMT inhibitors and clozapine provide new opportunities for the treatment
 of patients
with longstanding PD and fluctuating responses to levodopa. Experimental
 evidence in animals
suggests that glutamate antagonists have symptomatic and neuroprotective actions
 in PD. At
present, however, only weak antiglutamatergic drugs that have low specificity,
 such as
memantine, amantadine, and budipine are available for clinical studies.
 Neurotrophic factors, in
particular ciliary neurotrophic factor and glial cell line-derived neurotrophic
 factor, are among the
most promising new approaches for neuroprotection in PD. Problems of
 bioavailability, however,
thus far preclude their use in patients. An improved understanding of the
 pathophysiology of
parkinsonism has led to a renaissance of stereotaxic surgery. The subthalamic
 nucleus is a
potential new target for surgical intervention. Ventroposterior pallidotomy has
 been shown to
improve not only rigidity and tremor, but also akinesia. The techniques for
 thalamic interventions
have been refined by introducing chronic thalamic stimulation. Future
 transplantation approaches
to PD will focus on the use of genetically modified cells carrying genes for
 dopamine-synthesizing
enzymes or neurotrophic factors. Animal studies show the feasibility of in vivo
 gene transfer for
the treatment of PD. (53 Refs.)
 
09100649 95030649
Iacono RP; Lonser RR; Mandybur G; Morenski JD; Yamada S; Shima F
Stereotactic pallidotomy results for Parkinson's exceed those of fetal graft.
Division of Neurosurgery, Loma Linda University Medical Center, California.
Am Surg (UNITED STATES) Oct 1994, 60 (10) p777-82
 
Fetal graft research and renewed interest in Leksell's postero-ventral
 pallidotomy (PVP)
stimulated reconsideration of surgical therapy for Parkinson's disease (PD),
 particularly with
regard to improving akinetic symptoms previously thought resistant to surgical
 lesions. Review of
our series and other published results of PVP and fetal graft show that PVP has
 beneficial effects
on both akinetic and hyperkinetic symptoms that better the results reported for
 fetal graft
implantation and other conventional stereotactics. Presented are the results of
 60 consecutive
patients, 55 of whom underwent PVP, and 5 who underwent fetal graft
 implantation. Using the
Unified Parkinson's Disease Rating Scale (UPDRS), we found that PVP gave
 significant (P <
0.05) reductions in akinetic symptomatology including freezing, arising from a
 chair, posture, gait,
postural instability, and bradykinesia. Fetal graft patients had significant
 reductions in two akinetic
symptoms: bradykinesia and postural instability. PVP's dramatic therapeutic
 effects on akinesia
may be explained by interruption of amplified collateral inhibitory output from
 the pallidum to
brain stem locomotor centers such as the pedunculopontine nucleus, whereas
 interruption of
collaterals to ventral lateral thalamus by PVP may account for the elimination
 of hyperkinesia. The
excellent results of PVP represent a significant advance in the surgical
 treatment of PD. (33 Refs.)
 
08845021 94160021
Rand RW; Jacques DB; Melbye RW; Copcutt BG; Fisher MR; Levenick MN
Gamma Knife thalamotomy and pallidotomy in patients with movement disorders:
 preliminary results.
 Neurosciences Institute, Hospital of the Good Samaritan, Los Angeles, Calif.
Stereotact Funct Neurosurg (SWITZERLAND) 1993, 61 Suppl 1 p65-92
 
The Leksell Gamma Knife is a useful and safe method to perform thalamotomy and
 pallidotomy
in selected older patients with Parkinson's disease and related movement
 disorders. In this
preliminary report, 2 of 3 patients with severe intention tremor were relieved
 of their symptoms
by thalamotomy, as were 4 of 7 patients with Parkinson's tremor. Four of 8
 patients had
significant improvement of contralateral rigidity following pallidotomy.
 
08818819 94133819
Iacono RP; Lonser RR
Reversal of Parkinson's akinesia by pallidotomy [letter]
Lancet (ENGLAND) Feb 12 1994, 343 (8894) p418-9,
08789104 94104104
Komai N
[Surgical treatment of Parkinson's disease] In Japanese
Department of Neurological Surgery, Wakayama Medical College.
Nippon Rinsho (JAPAN) Nov 1993, 51 (11) p2940-6
 
Surgical treatment for Parkinson's disease began by blocking of the pyramidal
 system in early part
of this era. In 1942, Meyers performed Ansotomy for the treatment of
 Parkinsonism without
leaving hemiplegia, leading subsequent operating target to blocking of
 pallidofugal fiber. Then, the
development of stereotaxy in 1947 caused an operative progress to Pallidotomy
 and further to
Thalamotomy. Although the spread of levodopa therapy gradually brought about
 decline of
surgical treatment, Thalamotomy became to be reexamined in view of not a little
 problems about
and side effects of levodopa therapy. With the development of CT, MRI and the
 like,
Thalamotomy via MRI-stereotaxy was developed, making operations safer and surer.
 Besides,
transplantation of dopamine neurons into the striatum was tried as an essential
 treatment and is in
clinical application via animal experiments. Fetal ventral mesencephalic tissue
 and adrenal
medullary tissue are available therefore, but demerits are such that the former
 poses some ethical
problem and the latter is poor and short-lived response. The transplantation of
 stellate ganglion
into the striatum, which we have recently developed is safe and more effective
 than the adrenal
medullary tissue. The respective one thirds of the cases did without levodopa
 following
transplantation, needed half as much as the preoperative levodopa dose and
 needed the same as
the latter. Although Horner's syndrome was noted in all cases following
 transplantation, no
Parkinson syndrome became aggravated in any one of the cases. (15 Refs.)
 
08573757 93283757
Widner H; Rehncrona S
Transplantation and surgical treatment of parkinsonian syndromes.
Department of Neurology, University Hospital, Lund, Sweden.
Curr Opin Neurol Neurosurg (UNITED STATES) Jun 1993, 6 (3) p344-9
 
Neurosurgical attempts to correct parkinsonism use strategies aimed either at
 alleviating the
underlying dopamine deficiency or at correcting abnormal compensatory effects in
 neural circuits
within the basal ganglia. During the review period, clinical trials of four
 different neurosurgical
approaches were reported. These approaches are intracerebral transplantation of
 fetal dopamine
neurons, intracerebral transplantation of adrenal medullary tissue,
 tremor-reducing surgical lesions
in the ventrolateral thalamus, and ventroposterior pallidotomy aimed at reducing
 akinesia and
rigidity. Experimental studies in rats and monkeys designed to explore
 mechanisms of graft
actions were also reported. (33 Refs.)
 
08430974 93140974
Goetz CG; De Long MR; Penn RD; Bakay RA
Neurosurgical horizons in Parkinson's disease.
Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical
 Center, Chicago, IL 60612.
Neurology (UNITED STATES) Jan 1993, 43 (1) p1-7
 
Based on recent neuroanatomic and physiologic discoveries, neurosurgical
 therapies may
increasingly complement and extend pharmacologic management of Parkinson's
 disease.
Procedures showing promise include subthalamotomy and pallidotomy; thalamic
 electrical
stimulation may also offer application for tremor control. Transplantation of
 adrenal chromaffin
cells has not been associated with consistent long-term improvement in most
 patients, and fetal
mesencephalic transplantation remains controversial. Trophic factors that may be
 pivotal to
cellular repair and survival of transplanted tissue have potential therapeutic
 roles when purified
and perfused centrally or when the cells that produce the factors are
 transplanted. (92 Refs.)
 
08357680 93067680
Laitinen LV; Bergenheim AT; Hariz MI
Ventroposterolateral pallidotomy can abolish all parkinsonian symptoms.
Department of Neurosurgery, Sophiahemmet Hospital, Stockholm, Sweden.
 Stereotact Funct Neurosurg (SWITZERLAND) 1992, 58 (1-4) p14-21
 
Stereotactic ventroposterolateral pallidotomy in 46 parkinsonian patients
 resulted in a complete
or almost complete and long-lasting relief of rigidity and hypokinesia in 91% of
 the patients. Good
tremor effect was obtained in 80% of them. The L-dopa-induced dyskinesias, gait
 and speech
improved in most patients. Complications were observed in 7 cases after 51
 pallidotomies, i.e.
14% (partial homonymous hemianopia in 6 and transient dysphasia and facial
 weakness in 1). We
believe that the good effect of surgery is based on interruption of some
 striopallidal or
subthalamopallidal pathways.
 
08238679 92376679
Taira T; Kawamura H; Tanikawa T; Iseki H; Amano K
Unexpected movement disorders in neurosurgical practice: report of three cases.
Department of Neurosurgery, Tokyo Women's Medical College, Japan.
Surg Neurol (UNITED STATES) Aug 1992, 38 (2) p135-40
 
Hyperkinetic movement disorders may develop as a complication of stereotactic
 thalamotomy or
pallidotomy. However, such movement disorders are uncommon after nonsterotactic
 intracranial
operations. The authors report three cases of involuntary movement disorders
 unexpectedly
developing after intracranial operations. The patients had undergone clipping of
 an internal carotid
aneurysm, removal of an intracerebral hematoma, and resection of a tentorial
 meningioma. Two
patients developed choreic movements and a dystonic posture of the unilateral
 upper extremity.
One patient showed a tremor that had features of both parkinsonism and essential
 tremor. The
symptoms of these patients were medically uncontrollable, and they were
 successfully treated
with stereotactic ventrolateral thalamotomy.
 
07941042 92079042
Laitinen LV; Bergenheim AT; Hariz MI
Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease
 [see comments].
Department of Neurosurgery, Sophiahemmet Hospital, Stockholm, Sweden.
J Neurosurg (UNITED STATES) Jan 1992, 76 (1) p53-61
 
Between 1985 and 1990, the authors performed stereotactic posteroventral
 pallidotomies on 38
patients with Parkinson's disease whose main complaint was hypokinesia. Upon
 re-examination 2
to 71 months after surgery (mean 28 months), complete or almost complete relief
 of rigidity and
hypokinesia was observed in 92% of the patients. Of the 32 patients who before
 surgery also
suffered from tremor, 26 (81%) had complete or almost complete relief of tremor.
 The
L-dopa-induced dyskinesias and muscle pain had greatly improved or disappeared
 in most
patients, and gait and speech volume also showed remarkable improvement.
 Complications were
observed in seven patients: six had a permanent partial homonymous hemianopsia
 (one also had
transient dysphasia and facial weakness) and one developed transitory
 hemiparesis 1 week after
pallidotomy. The results presented here confirm the 1960 findings of Svennilson,
 et al., that
parkinsonian tremor, rigidity, and hypokinesia can be effectively abolished by
 posteroventral
pallidotomy, an approach developed in 1956 and 1957 by Lars Leksell. The
 positive effect of
posteroventral pallidotomy is believed to be based on the interruption of some
 striopallidal or
subthalamopallidal pathways, which results in disinhibition of medial pallidal
 activity necessary for
movement control.
 
07661491 91180491
Hariz MI
Correlation between clinical outcome and size and site of the lesion in computed
 tomography guided thalamotomy and pallidotomy.
Department of Neurosurgery, University Hospital, Ume.ANG.a, Sweden.
Stereotact Funct Neurosurg (SWITZERLAND) 1990, 54-55 p172-85
 
Fourteen thalamotomies and five pallidotomies were performed in 19 patients with
 hereditary
intention tremor or Parkinson's disease. The target coordinates were determined
 by a stereotactic
computed tomography study using the Laitinen noninvasive stereoadapter. Surgery
 was done
without ventriculography. The patients were assessed 3-12 months later. In a
 postoperative
stereotactic computed tomography study, the positions of the thalamic and
 pallidal targets were
marked, and the coordinates of the center of the lesion were measured in
 relation to these targets.
The volume of the lesion was calculated. In 3 thalamic lesion patients, no
 lesion could be
visualized. The size of the eleven visible thalamic lesions ranged from 4 to 75
 mm3 (mean 26),
and the size of the 5 pallidal lesions ranged from 28 to 150 mm3 (mean 67). On
 the average, the
center of the lesion was 1.4 mm medial to the position of the anatomical target
 (p less than
0.002). Neither size nor site of the lesion correlated with the clinical
 outcome.
 
05993434 86294434
Burzaco J
Stereotactic pallidotomy in extrapyramidal disorders.
Appl Neurophysiol (SWITZERLAND) 1985, 48 (1-6) p283-7
 
The results of stereotactic pallidotomy in 37 patients with extrapyramidal
 disorders are presented.
All patients had the same RF lesions and target coordinates. The patients are
 classified into 5
groups according to the clinical picture. These results are compared with those
 obtained by
thalamotomy in a similar group of patients. The main indications for pallidotomy
 are given. The
spatial representation of globus pallidus medialis according to Andrews and
 Watkins, Talairach
and the author are shown and their differences discussed.
 
.
 
John Cottingham                     [log in to unmask]