High-frequency stimulation of the globus pallidus internalis in Parkinson's disease: a study of seven cases

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  • 1 Laboratoire de Neurophysiologie, Université Victor Segalen Bordeaux II, Bordeaux, France; Service de Neurochirurgie, Hôpital Pellegrin, Bordeaux, France; and Service de Neurologie, Hôpital du Haut Lévèque, Pessac, France
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✓ The effectiveness of ventroposterolateral pallidotomy in the treatment of akinesia and rigidity is not a new discovery and agrees with recent investigations into the pathogenesis of Parkinson's disease, which highlight the role played by the unbridled activity of the subthalamic nucleus (STN) and the consequent overactivity of the globus pallidus internalis (GPi). Because high-frequency stimulation can reversibly incapacitate a nerve structure, we applied stimulation to the same target.

Seven patients suffering from severe Parkinson's disease (Stages III–V on the Hoehn and Yahr scale) and, particularly, bradykinesia, rigidity, and levodopa-induced dyskinesias underwent unilateral electrode implantation in the posteroventral GPi. Follow-up evaluation using the regular Unified Parkinson's Disease Rating Scale has been conducted for 1 year in all seven patients, 2 years in five of them, and 3 years in one. In all cases high-frequency stimulation has alleviated akinesia and rigidity and has generally improved gait and speech disturbances. In some cases tremor was attenuated. In a similar manner, the authors observed a marked diminution in levodopa-induced dyskinesias. This could be an excellent primary therapy for younger patients exhibiting severe bradykinesia, rigidity, and levodopa-induced dyskinesias, which would allow therapists to keep ventroposterolateral pallidotomy in reserve as a second weapon.

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Contributor Notes

Address reprint requests to: Christian Gross, Ph.D., Laboratoire de Neurophysiologie, Centre Nationale de la Recherche Scientifique, Unité Mixte de Recherche, 5543, Université Victor Segalen Bordeaux II, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France.
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