Deep brain stimulation of the corpus luysi (subthalamic nucleus) and other targets in Parkinson’s disease. Extension to new indications such as dystonia and epilepsy

Alim Louis Benabid, Adnan Koudsié, Abdelhamid Benazzouz, Laurent Vercueil, Valérie Fraix, Stéphan Chabardes, Jean François LeBas, Pierre Pollak
J Neurol. 2001-09-01; 248(S3): 37-47
DOI: 10.1007/pl00007825

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1. J Neurol. 2001 Sep;248 Suppl 3:III37-47. doi: 10.1007/pl00007825.

Deep brain stimulation of the corpus luysi (subthalamic nucleus) and other
targets in Parkinson’s disease. Extension to new indications such as dystonia
and epilepsy.

Benabid AL(1), Koudsie A, Benazzouz A, Vercueil L, Fraix V, Chabardes S, Lebas
JF, Pollak P.

Author information:
(1)Department of Neurosurgery, CHU A Michallon, Grenoble, France.

Chronic high frequency (130 Hz) stimulation (HFS) of the thalamic target Vim,
first used in our group in 1987 as a treatment of tremor of various origins, has
been used over the last ten years in 137 patients. Since 1993, this method has
been extended to two other targets (subthalamic nucleus (STN): 137 patients and
the medial pallidum (GPi): 12 patients), based on recent experimental data in
rats and monkeys. STN appears to be a target of major interest, able to control
the three cardinal symptoms and to allow the decrease or suppression of levodopa
treatment, which then also suppresses levodopa induced dyskinesias. The
stereotactic technique is based on the determination of the target using
ventriculography, MRI and electrophysiology, with both microrecording of single
neuron activity and microstimulation inducing therapeutic symptom suppression
and side effects. Chronic electrodes are then placed bilaterally at the best
physiologically defined location and then connected to implantable stimulators
(either 2 Itrel II or the new double channel Kinetra), operated at 130-185 Hz,
60 ms pulse width, 2.5 to 3.5 volts. There was no operative mortality and
permanent morbidity was observed in 3 patients. The mechanisms of action of HFS
are not fully understood, but are definitely related to high frequency and are
probably different depending on the target. Inhibition of cellular activity or
of neural network functions could be induced, by jamming of a retroactive loop
for tremor, or by shutdown of neurotransmitter release in STN. Mechanisms within
an individual target are also probably different for tremor or for other symptom
alleviation. All cardinal symptoms are alleviated from tremor to akinesia and
rigidity. This strong improvement allows the decrease of the drug dosage to
approximately 30% of the preoperative level, which suppresses the
levodopa-induced dyskinesias. The off period dystonias are also suppressed as
well as freezings and falls. The effects remain stable over more than 5 years
and in the same period, the off stimulation-off medication UPDRS remains stable
and does not increase at the usual rate The low rate of permanent complications,
the minor side effects and their immediate reversibility, the possibility of
bilateral implantation in one session and the long-term persistence of symptom
relief are strong arguments which support chronic HFS of STN as the method of
choice when a surgical procedure is indicated for the treatment of Parkinson’s
disease and even more when a bilateral procedure is necessary. Recent data show
that STN stimulation could be useful in the treatment of dystonia as well as
some forms of epilepsy. It is therefore possible that DBS in STN as well as in
other targets could become a potent therapeutic tool in the near future for
neurological disorders.

DOI: 10.1007/pl00007825
PMID: 11697687 [Indexed for MEDLINE]

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