Predictors of neuropsychological outcome in patients following microelectrode-guided pallidotomy for Parkinson's disease

Restricted access

Object. The authors studied neuropsychological performance following microelectrode-guided posteroventral pallidotomy in patients with Parkinson's disease (PD) and evaluated correlations with presurgical and surgical factors.

Methods. Neuropsychological changes 3 months (43 patients) and 12 months (27 patients) after microelectrode-guided pallidotomy for PD are reported in a series of 44 consecutive patients with the disease, who improved neurologically, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS) in both the “off” (p < 0.001) and best “on” (p < 0.001) states.

Findings of the vocabulary subtest of the Wechsler Adult Intelligence Scale—Revised (p < 0.01), Letter Fluency (p < 0.001), Verbal Fluency for semantic categories (p < 0.001), and the Wisconsin Card Sorting Test (p < 0.01) showed a significant decline in neuropsychological performance in patients 3 months after undergoing left-sided pallidotomy. Impairment in the language domain (semantic fluency) persisted at the 12-month follow-up examination (p < 0.01). Visual memory improved after right-sided pallidotomies (p < 0.01 after 3 months), with a nonsignificant trend toward persistent improvement 1 year postsurgery (p < 0.02 after 12 months). Preoperative semantic fluency was influenced by patient age (p < 0.001) and by the width of the third ventricle (p < 0.05), as measured by magnetic resonance imaging.

A regression model revealed that semantic fluency 3 months postoperatively was significantly affected by the baseline score (p < 0.001), side of surgery (p < 0.001), handedness (p < 0.01), and patient age (p < 0.05). However, postoperative lesion volume, lesion location, number of tracks, number of lesions, distance from anatomical landmarks, or UPDRS score did not significantly contribute to neuropsychological outcome.

Conclusions. Neuropsychological changes in a cohort of patients with PD who underwent pallidotomy and experienced excellent clinical benefits and minimum postoperative complications, emphasize the importance of neuropsychological examinations and further investigation of predictive factors.

Article Information

Address reprint requests to: Robert E. Wharen, Jr., M.D., Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, Florida 32224. email: wharen@mayo.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Reformatted MR images revealing an average lesion (arrows) in the axial and coronal planes. The lesioning trajectory, planned target (black square), final target after microelectrode recording (white circle), and actual lesion tip (×) of this patient is displayed in the parasagittal plane.

  • View in gallery

    Scatterplot showing changes in semantic fluency and lesion location projected onto an axial plane (normalized to a 23-mm AC—PC line) 3 months after surgery. MAC—PC = midpoint of AC—PC line.

  • View in gallery

    Scatterplot showing changes in semantic fluency and lesion location projected onto a sagittal plane (normalized to a 23-mm AC—PC line) 3 months after surgery.

References

  • 1.

    Alterman RLKall BBeric Aet al: Pallidal targeting with the COMPASS system. Stereotact Funct Neurosurg 69:69721997Alterman RL Kall B Beric A et al: Pallidal targeting with the COMPASS system. Stereotact Funct Neurosurg 69:69–72 1997

  • 2.

    Baron MSVitek JLBakay RAEet al: Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study. Ann Neurol 40:3553661996Baron MS Vitek JL Bakay RAE et al: Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study. Ann Neurol 40:355–366 1996

  • 3.

    Benton ALHamsher KD: Multilingual Aphasia Examination. Iowa City: AJA Associates1983Benton AL Hamsher KD: Multilingual Aphasia Examination. Iowa City: AJA Associates 1983

  • 4.

    Benton ALVarney NRHamsher KD: Visuospatial judgment. A clinical test. Arch Neurol 35:3643671978Benton AL Varney NR Hamsher KD: Visuospatial judgment. A clinical test. Arch Neurol 35:364–367 1978

  • 5.

    Burns JMWilkinson SKieltyka Jet al: Analysis of pallidotomy lesion positions using three-dimensional reconstruction of pallidal lesions, the basal ganglia, and the optic tract. Neurosurgery 41:130313181997Burns JM Wilkinson S Kieltyka J et al: Analysis of pallidotomy lesion positions using three-dimensional reconstruction of pallidal lesions the basal ganglia and the optic tract. Neurosurgery 41:1303–1318 1997

  • 6.

    Burns JMWilkinson SOverman Jet al: Magnetic resonance image evaluation of pallidotomy lesions: a volumetric and shape analysis. Neurosurg Focus 2 (3):Article 31997Burns JM Wilkinson S Overman J et al: Magnetic resonance image evaluation of pallidotomy lesions: a volumetric and shape analysis. Neurosurg Focus 2 (3):Article 3 1997

  • 7.

    Cahn DASullivan EVShear PKet al: Neuropsychological and motor functioning after unilateral anatomically guided posterior ventral pallidotomy. Preoperative performance and three-month follow-up. Neuropsychiatry Neuropsychol Behav Neurol 11:1361451998Cahn DA Sullivan EV Shear PK et al: Neuropsychological and motor functioning after unilateral anatomically guided posterior ventral pallidotomy. Preoperative performance and three-month follow-up. Neuropsychiatry Neuropsychol Behav Neurol 11:136–145 1998

  • 8.

    Delis DKramer JKaplan Eet al: California Verbal Learning Test. San Antonio: Psychological Corporation1987Delis D Kramer J Kaplan E et al: California Verbal Learning Test. San Antonio: Psychological Corporation 1987

  • 9.

    Elwan OHBaradah OHMadkour Oet al: Parkinson's disease, cognition and aging. Clinical, neuropsychological, electrophysiological and cranial computerized tomographic assessment. J Neurol Sci 143:64711996Elwan OH Baradah OH Madkour O et al: Parkinson's disease cognition and aging. Clinical neuropsychological electrophysiological and cranial computerized tomographic assessment. J Neurol Sci 143:64–71 1996

  • 10.

    Fukui TSato YIchikawa Het al: Evaluation of influential factors of cognitive impairments in idiopathic Parkinson's disease. Eur Neurol 35:86921995Fukui T Sato Y Ichikawa H et al: Evaluation of influential factors of cognitive impairments in idiopathic Parkinson's disease. Eur Neurol 35:86–92 1995

  • 11.

    Goodglass HKaplan E: The Assessment of Aphasia and Related Disordersed 2. Philadelphia: Lea & Febiger1983Goodglass H Kaplan E: The Assessment of Aphasia and Related Disorders ed 2. Philadelphia: Lea & Febiger 1983

  • 12.

    Gregory R: Unilateral pallidotomy for advanced Parkinson's disease. Brain 122:3813821999 (Editorial)Gregory R: Unilateral pallidotomy for advanced Parkinson's disease. Brain 122:381–382 1999 (Editorial)

  • 13.

    Gross RELombardi WJHutchison WDet al: Variability in lesion location after microelectrode-guided pallidotomy for Parkinson's disease: anatomical, physiological, and technical factors that determine lesion distribution. J Neurosurg 90:4684771999Gross RE Lombardi WJ Hutchison WD et al: Variability in lesion location after microelectrode-guided pallidotomy for Parkinson's disease: anatomical physiological and technical factors that determine lesion distribution. J Neurosurg 90:468–477 1999

  • 14.

    Gross RELombardi WJLang AEet al: Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease. Brain 122:4054161999Gross RE Lombardi WJ Lang AE et al: Relationship of lesion location to clinical outcome following microelectrode-guided pallidotomy for Parkinson's disease. Brain 122:405–416 1999

  • 15.

    Guridi JGorospe ARamos Eet al: Stereotactic targeting of the globus pallidus internus in Parkinson's disease: imaging versus electrophysiological mapping. Neurosurgery 45:2782891999Guridi J Gorospe A Ramos E et al: Stereotactic targeting of the globus pallidus internus in Parkinson's disease: imaging versus electrophysiological mapping. Neurosurgery 45:278–289 1999

  • 16.

    Heaton RKChelune GJTalley JLet al: Wisconsin Card Sorting Test Manual. Odessa: Psychological Assessment Resources1993Heaton RK Chelune GJ Talley JL et al: Wisconsin Card Sorting Test Manual. Odessa: Psychological Assessment Resources 1993

  • 17.

    Holtzheimer PE IIIRoberts DWDarcey TM: Magnetic resonance imaging versus computed tomography for target localization in functional stereotactic neurosurgery. Neurosurgery 45:2902981999Holtzheimer PE III Roberts DW Darcey TM: Magnetic resonance imaging versus computed tomography for target localization in functional stereotactic neurosurgery. Neurosurgery 45:290–298 1999

  • 18.

    Junque CAlegret MNobbe FAet al: Cognitive and behavioral changes after unilateral posteroventral pallidotomy: relationship with lesional data from MRI. Mov Disord 14:7807891999Junque C Alegret M Nobbe FA et al: Cognitive and behavioral changes after unilateral posteroventral pallidotomy: relationship with lesional data from MRI. Mov Disord 14:780–789 1999

  • 19.

    Krauss JKDesaloms JMLai ECet al: Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's diease: postoperative magnetic resonance imaging analysis. J Neurosurg 87:3583671997Krauss JK Desaloms JM Lai EC et al: Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's diease: postoperative magnetic resonance imaging analysis. J Neurosurg 87:358–367 1997

  • 20.

    Laitinen LVBergenheim ATHariz MI: Ventroposterolateral pallidotomy can abolish all parkinsonian symptoms. Stereotact Funct Neurosurg 58:14211992Laitinen LV Bergenheim AT Hariz MI: Ventroposterolateral pallidotomy can abolish all parkinsonian symptoms. Stereotact Funct Neurosurg 58:14–21 1992

  • 21.

    Lang AELozano AMMontgomery Eet al: Posteroventral medial pallidotomy in advanced Parkinson's disease. N Engl J Med 337:103610421997Lang AE Lozano AM Montgomery E et al: Posteroventral medial pallidotomy in advanced Parkinson's disease. N Engl J Med 337:1036–1042 1997

  • 22.

    Langston JWWidner HGoetz CGet al: Core assessment program for intracerebral transplantations (CAPIT). Mov Disord 7:2131992Langston JW Widner H Goetz CG et al: Core assessment program for intracerebral transplantations (CAPIT). Mov Disord 7:2–13 1992

  • 23.

    Lezak MD: Neuropsychological Assessmented 3. New York: Oxford University Press1995Lezak MD: Neuropsychological Assessment ed 3. New York: Oxford University Press 1995

  • 24.

    Lozano AHutchison WKiss Zet al: Methods for micro-electrode-guided posteroventral pallidotomy. J Neurosurg 84:1942021996Lozano A Hutchison W Kiss Z et al: Methods for micro-electrode-guided posteroventral pallidotomy. J Neurosurg 84:194–202 1996

  • 25.

    Lozano AMLang AE: Pallidotomy for Parkinson's disease. Neurosurg Clin North Am 9:3253361998Lozano AM Lang AE: Pallidotomy for Parkinson's disease. Neurosurg Clin North Am 9:325–336 1998

  • 26.

    Lucas JAFinton MJRippeth JDet al: Long-term lateralized effects of pallidotomy on verbal fluency. J Int Neuropsychol Soc 5:941999 (Abstract)Lucas JA Finton MJ Rippeth JD et al: Long-term lateralized effects of pallidotomy on verbal fluency. J Int Neuropsychol Soc 5:94 1999 (Abstract)

  • 27.

    Lucas JAIvnik RJSmith GEet al: Mayo's older Americans normative studies: category fluency norms. J Clin Exp Neuropsychol 20:1942001998Lucas JA Ivnik RJ Smith GE et al: Mayo's older Americans normative studies: category fluency norms. J Clin Exp Neuropsychol 20:194–200 1998

  • 28.

    Masterman DDeSalles ABaloh RWet al: Motor, cognitive, and behavioral performance following unilateral ventroposterior pallidotomy for Parkinson disease. Arch Neurol 55:120112081998Masterman D DeSalles A Baloh RW et al: Motor cognitive and behavioral performance following unilateral ventroposterior pallidotomy for Parkinson disease. Arch Neurol 55:1201–1208 1998

  • 29.

    Mattis S: Mental status examination for organic mental syndrome in the elderly patient in Bellak LKarasu TBBirenbaum C (eds): Geriatric Psychiatry: A Handbook for Psychiatrists and Primary Care Physicians. New York: Grune & Stratton1976 pp 77121Mattis S: Mental status examination for organic mental syndrome in the elderly patient in Bellak L Karasu TB Birenbaum C (eds): Geriatric Psychiatry: A Handbook for Psychiatrists and Primary Care Physicians. New York: Grune & Stratton 1976 pp 77–121

  • 30.

    Merello MNouzeilles MIKuzis Get al: Unilateral radiofrequency lesion versus electrostimulation of posteroventral pallidum: a prospective randomized comparison. Mov Disord 14:50561999Merello M Nouzeilles MI Kuzis G et al: Unilateral radiofrequency lesion versus electrostimulation of posteroventral pallidum: a prospective randomized comparison. Mov Disord 14:50–56 1999

  • 31.

    Perrine KDogali MFazzini Eet al: Cognitive functioning after pallidotomy for refractory Parkinson's disease. J Neurol Neurosurg Psychiatry 65:1501541998Perrine K Dogali M Fazzini E et al: Cognitive functioning after pallidotomy for refractory Parkinson's disease. J Neurol Neurosurg Psychiatry 65:150–154 1998

  • 32.

    Reitan RWolfson D: The Halstead-Reitan Neuropsychological Battery. Tucson: Neuropsychology Press1985Reitan R Wolfson D: The Halstead-Reitan Neuropsychological Battery. Tucson: Neuropsychology Press 1985

  • 33.

    Rettig GMLai ECKrauss JKet al: Neuropsychological evaluation of patients with Parkinson's disease before and after pallidal surgery in Krauss JKGrossman RGJankovic J (eds): Pallidal Surgery for the Treatment of Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott-Raven1998 pp 211231Rettig GM Lai EC Krauss JK et al: Neuropsychological evaluation of patients with Parkinson's disease before and after pallidal surgery in Krauss JK Grossman RG Jankovic J (eds): Pallidal Surgery for the Treatment of Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott-Raven 1998 pp 211–231

  • 34.

    Riordan HJFlashman LARoberts DW: Neurocognitive and psychosocial correlates of ventroposterolateral pallidotomy surgery in Parkinson's disease. Neurosurg Focus 2 (3):Article 71997Riordan HJ Flashman LA Roberts DW: Neurocognitive and psychosocial correlates of ventroposterolateral pallidotomy surgery in Parkinson's disease. Neurosurg Focus 2 (3):Article 7 1997

  • 35.

    Rippeth JDLucas JAFinton MJet al: Neuropsychological measures associated with financial aptitude in an older clinical population. Clin Neuropsychologist 12:2701998(Abstract)Rippeth JD Lucas JA Finton MJ et al: Neuropsychological measures associated with financial aptitude in an older clinical population. Clin Neuropsychologist 12:270 1998 (Abstract)

  • 36.

    Samii ATurnbull IMKishore Aet al: Reassessment of unilateral pallidotomy in Parkinson's disease. A 2-year follow-up study. Brain 122:4174251999Samii A Turnbull IM Kishore A et al: Reassessment of unilateral pallidotomy in Parkinson's disease. A 2-year follow-up study. Brain 122:417–425 1999

  • 37.

    Schaltenbrand GWahren P: Atlas for Stereotaxy of the Human Brain. Stuttgart: Thieme1977Schaltenbrand G Wahren P: Atlas for Stereotaxy of the Human Brain. Stuttgart: Thieme 1977

  • 38.

    Scott RGregory RHines Net al: Neuropsychological, neurological and functional outcome following pallidotomy for Parkinson's disease. A consecutive series of eight simultaneous bilateral and twelve unilateral procedures. Brain 121:6596751998Scott R Gregory R Hines N et al: Neuropsychological neurological and functional outcome following pallidotomy for Parkinson's disease. A consecutive series of eight simultaneous bilateral and twelve unilateral procedures. Brain 121:659–675 1998

  • 39.

    Soukup VMIngram FSchiess MCet al: Cognitive sequelae of unilateral posteroventral pallidotomy. Arch Neurol 54:9479501997Soukup VM Ingram F Schiess MC et al: Cognitive sequelae of unilateral posteroventral pallidotomy. Arch Neurol 54:947–950 1997

  • 40.

    Starr PAVitek JLDeLong Met al: Magnetic resonance imaging-based stereotactic localization of the globus pallidus and subthalamic nucleus. Neurosurgery 44:3033141999Starr PA Vitek JL DeLong M et al: Magnetic resonance imaging-based stereotactic localization of the globus pallidus and subthalamic nucleus. Neurosurgery 44:303–314 1999

  • 41.

    Starr PAVitek JLDeLong Met al: Pallidotomy: theory and technique. Tech Neurosurg 5:31451999Starr PA Vitek JL DeLong M et al: Pallidotomy: theory and technique. Tech Neurosurg 5:31–45 1999

  • 42.

    Trépanier LLSaint-Cyr JALozano AMet al: Neuropsychological consequences of posteroventral pallidotomy for the treatment of Parkinson's disease. Neurology 51:2072151998Trépanier LL Saint-Cyr JA Lozano AM et al: Neuropsychological consequences of posteroventral pallidotomy for the treatment of Parkinson's disease. Neurology 51:207–215 1998

  • 43.

    Tröster AIFields JAWilkinson SBet al: Unilateral pallidal stimulation for Parkinson's disease: neurobehavioral functioning before and 3 months after electrode implantation. Neurology 49:107810831997Tröster AI Fields JA Wilkinson SB et al: Unilateral pallidal stimulation for Parkinson's disease: neurobehavioral functioning before and 3 months after electrode implantation. Neurology 49:1078–1083 1997

  • 44.

    Tröster AIStalp LDPaolo AMet al: Neuropsychological impairment in Parkinson's disease with and without depression. Arch Neurol 52:116411691995Tröster AI Stalp LD Paolo AM et al: Neuropsychological impairment in Parkinson's disease with and without depression. Arch Neurol 52:1164–1169 1995

  • 45.

    Tsao KWilkinson SOverman Jet al: Pallidotomy lesion locations: significance of microelectrode refinement. Neurosurgery 43:5065131998Tsao K Wilkinson S Overman J et al: Pallidotomy lesion locations: significance of microelectrode refinement. Neurosurgery 43:506–513 1998

  • 46.

    Uitti RJWharen RELucas JAet al: Unilateral pallidotomy for Parkinson's disease: speech, motor, and neuropsychological outcome measurements. Parkinsonism Rel Disord 6:1331432000Uitti RJ Wharen RE Lucas JA et al: Unilateral pallidotomy for Parkinson's disease: speech motor and neuropsychological outcome measurements. Parkinsonism Rel Disord 6:133–143 2000

  • 47.

    Uitti RJWharen RE JrTurk MFet al: Unilateral pallidotomy for Parkinson's disease: comparison of outcome in younger versus elderly patients. Neurology 49:107210771997Uitti RJ Wharen RE Jr Turk MF et al: Unilateral pallidotomy for Parkinson's disease: comparison of outcome in younger versus elderly patients. Neurology 49:1072–1077 1997

  • 48.

    Wechsler D: Wechsler Adult Intelligence Scale—Revised. New York: Psychological Corporation1981Wechsler D: Wechsler Adult Intelligence Scale—Revised. New York: Psychological Corporation 1981

  • 49.

    Wechsler D: Wechsler Memory Scale—Revised Manual. San Antonio: Psychological Corporation1987Wechsler D: Wechsler Memory Scale—Revised Manual. San Antonio: Psychological Corporation 1987

  • 50.

    Yesavage JABrink TLRose TLet al: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37491982Yesavage JA Brink TL Rose TL et al: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49 1982

  • 51.

    Yokoyama TImamura YSugiyama Ket al: Prefrontal dysfunction following unilateral posteroventral pallidotomy in Parkinson's disease. J Neurosurg 90:100510101999Yokoyama T Imamura Y Sugiyama K et al: Prefrontal dysfunction following unilateral posteroventral pallidotomy in Parkinson's disease. J Neurosurg 90:1005–1010 1999

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 57 57 17
Full Text Views 142 142 0
PDF Downloads 87 87 0
EPUB Downloads 0 0 0

PubMed

Google Scholar