Subthalamic stimulation for Parkinson’s disease
Archives of Medical Research. 2000-05-01; 31(3): 282-289
DOI: 10.1016/S0188-4409(00)00077-1
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1. Arch Med Res. 2000 May-Jun;31(3):282-9. doi: 10.1016/s0188-4409(00)00077-1.
Subthalamic stimulation for Parkinson’s disease.
Benabid AL(1), Koudsié A, Benazzouz A, Fraix V, Ashraf A, Le Bas JF, Chabardes
S, Pollak P.
Author information:
(1)Department of Neurosciences, University Hospital of Grenoble, Grenoble,
France.
Deep brain stimulation by high frequency (HFS) has been developed starting in
the thalamic target (Vim) from pragmatic observations and subsequently followed
by other targets, such as the subthalamic nucleus (STN) and pallidum as an
application of current knowledge from basic preclinical research in
neuroscience. The mechanism involved by this neurosurgical approach is not
completely solved. For Vim we have formed the hypothesis that HFS induces a
jamming of sensory-motor loops but for the STN, from our experimental research
in rats we have shown that HFS induces functional inhibition of cell activity in
the target nuclei. In our patients the implantation of the stimulation
electrodes was carried out stereotactically, under local anesthesia, using
ventriculography, MRI, microrecordings and clinical evaluation of the effects of
stimulation on rigidity. When the stimulation is turned ON in the STN area a
significant decrease in rigidity was determined by the neurologists. Stimulation
or even penetration of the electrode may be responsible for transient
dyskinesias. The average location of the clinically efficient contact of the
chronic stimulating electrodes is statistically located at 5.02 +/- 0.71 1/12
degrees of AC-PC in the AP direction, at -1.5 +/- 0.66 1/8 degrees of the height
of the thalamus in the ventricle direction, with laterality at 11.98 +/- 1.12 mm
in the lateral direction. The beneficial effects of STN stimulation are
significant providing that the electrodes are correctly placed into the target.
There is strong improvement of the symptoms of the triad in which akinesia,
rigidity, and tremor are reduced on average to 41. 6, 48.6, and 27%,
respectively, when compared with the previous preoperative level. From our
experience, HFS of the STN could be considered the surgical therapy of choice at
advanced stages of Parkinson’s disease.
DOI: 10.1016/s0188-4409(00)00077-1
PMID: 11036179 [Indexed for MEDLINE]