TY - JOUR
T1 - Pallidotomy improves quality of life in selected parkinsonian patients: an Italian report.
AU - Iacopino, Domenico
AU - Lo Presti, Riccardo
AU - Iacopino, Domenico G.
AU - Iacopino, Domenico G.
AU - Lucerna, Sebastiano
AU - Di Bella, Paolo
AU - Sessa, Edoardo
AU - Salpietro, Francesco M.
AU - Bramanti, Placido
AU - Tomasello, Francesco
AU - Giller, Cole A.
PY - 1998
Y1 - 1998
N2 - Pallidotomy has recently been reconfirmed as effective for otherwise intractable symptoms of Parkinson's disease. Nonetheless almost every aspect of its performance requires choices which are not fully established and may vary between centers. These include: 1) patient selection; 2) choice of imaging modality, 3) choice of anatomic landmarks for targeting the lesion, 4) choice of method for physiologic confirmation of location, 5) choice of lesion size and shape. We present two cases of pallidotomy procedures in Parkinsonian patients that in our knowledge are the first reported in Italy. Our experience and a careful review of the literature led to the following choices: 1) selection of Parkinsonian patients with dominant L-Dopa induced dyskinesia, akinetic and rigidity symptoms, 2) use of CT due to the distortion effects of MRI, 3) use of standard (Laitinen) coordinates combined with an image fusion method using MRI, 4) use of stimulation to gauge distance to internal capsule and optic tract, 5) production of vertical lesion covering internal segment of pallidum. At a 1-year follow-up the results include a 45% drop in UPDRS (Unified Parkinson's Disease Rating Scale) motor score and almost complete resolution of contralateral dopa induced dyskinesias in both patients.
AB - Pallidotomy has recently been reconfirmed as effective for otherwise intractable symptoms of Parkinson's disease. Nonetheless almost every aspect of its performance requires choices which are not fully established and may vary between centers. These include: 1) patient selection; 2) choice of imaging modality, 3) choice of anatomic landmarks for targeting the lesion, 4) choice of method for physiologic confirmation of location, 5) choice of lesion size and shape. We present two cases of pallidotomy procedures in Parkinsonian patients that in our knowledge are the first reported in Italy. Our experience and a careful review of the literature led to the following choices: 1) selection of Parkinsonian patients with dominant L-Dopa induced dyskinesia, akinetic and rigidity symptoms, 2) use of CT due to the distortion effects of MRI, 3) use of standard (Laitinen) coordinates combined with an image fusion method using MRI, 4) use of stimulation to gauge distance to internal capsule and optic tract, 5) production of vertical lesion covering internal segment of pallidum. At a 1-year follow-up the results include a 45% drop in UPDRS (Unified Parkinson's Disease Rating Scale) motor score and almost complete resolution of contralateral dopa induced dyskinesias in both patients.
KW - Pallidotomy
KW - Parkinson disease
KW - surgical treatment movement disease
KW - Pallidotomy
KW - Parkinson disease
KW - surgical treatment movement disease
UR - http://hdl.handle.net/10447/63720
M3 - Article
VL - 13
SP - 105
EP - 115
JO - Functional Neurology
JF - Functional Neurology
SN - 0393-5264
ER -