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Lauri V. Laitinen, A. Tommy Bergenheim, and Marwan I. Hariz

pallidotomy in patients with Parkinson's disease; their patient remained free of symptoms for over 2 years. In the same year, Guiot and Brion 9 reported electrical coagulation of the pallidum. As a result of these reports, pallidotomy became a popular procedure in the 1950's, with the target in the anterodorsal part of the pallidum ( Fig. 1 ). However, the results of pallidotomy were not good; long-lasting improvement was mainly reported for rigidity only, while tremor and hypokinesia did not improve. 3 Lars Leksell in Lund, Sweden, began to perform anterodorsal

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Christian Gross, Alain Rougier, Dominique Guehl, Thomas Boraud, Jean Julien, and Bernard Bioulac

✓ 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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. Laitinen L , Vilkki J : Measurement of parkinsonian hypokinesia with Purdue pegboard and motor reaction time tests , in Siegfried J (ed): Parkinson's Disease. Berlin : Hans Huber , 1973 , Vol 2 , pp 185 – 192 Laitinen L, Vilkki J: Measurement of parkinsonian hypokinesia with Purdue pegboard and motor reaction time tests, in Siegfried J (ed): Parkinson's Disease. Berlin: Hans Huber, 1973, Vol 2, pp 185–192 4. Schaltenbrand G , Wahren W : Atlas for Stereotaxy of the Human Brain. Stuttgart

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Yukihiko Sonoda, Toshihiro Kumabe, Shin-Ichiro Sugiyama, Masayuki Kanamori, Yoji Yamashita, Ryuta Saito, Hisanori Ariga, Yoshihiro Takai, and Teiji Tominaga

precocious puberty 200 NP 300 NP 2 24, M pure germinoma BG lt hypokinesia 25 NP <1.0 NP 3 8, M mixed GCT BG rt hemiparesis (extr) 10.9 NP <1.0 NP 4 16, M pure germinoma BG rt convulsion, hyperkinesia NP NP 0.31 NP 5 11, M pure germinoma BG rt hemiparesis (extr) 1 NP 0.32 NP 6 12, M pure germinoma BG rt hemiparesis (extr) 2 NP 0.32 NP 7 12, M pure germinoma BG lt hemiparesis (face) 2 NP 1.2 NP 8 9, M germinoma w/ STGC BG lt

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Henry T. Wycis, William Cunningham, Garry Kellett, and Ernest A. Spiegel

O f the three cardinal symptoms of parkinsonism, tremor, rigidity, and bradykinesia, only tremor and rigidity have been materially reduced by surgical stereotaxic procedures. Bradykinesia and the probably related hypokinesia and akinesia, usually considered deficiency symptoms, persist after campotomy, ventrolateral thalamotomy, pallidotomy, and procedures producing lesions in other locations (centrum medianum, zona incerta, tegmentum, etc.). These experiences agreeing with those of other authors led to our investigation of further areas in an effort to reduce

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Marwan I. Hariz and A. Tommy Bergenheim

conducted either pre- or postoperatively, we tried to rate the severity of the symptoms on the side contralateral to pallidotomy in the same way as in the original publication from 1992. 11 That is, we extracted from the gathered reports whether the symptoms were nil or slight, moderate, or severe. We considered the following appendicular symptoms: tremor, rigidity, hypokinesia, dystonia and pain, and hyperkinesia. Additionally, gait, balance, and speech were rated in the same way. We also evaluated changes in the mental and social conditions of the patients during the

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Thomas Hofstetter, M. Javad Mirzayan, and Joachim K. Krauss

Hg. Protein concentration in the pulmonary fluid was 47.3 g/L and it was 48 g/L in the serum, indicating protein exudation. Cardiac ultra-sonography showed diffuse hypokinesia without left-sided ventricular dilation. The ejection fraction was reduced to 35%. There was no history of aspiration, intoxication, or trauma. Repeated CT scans of the head again revealed asymmetrical dilation of the ventricles with dislocation of the ventricular catheter. No CSF could be aspirated by puncture of the Rickham reservoir. Second Shunt Revision On revision of the

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Victor Goulenko, Paulo Luiz da Costa Cruz, and Paulo Niemeyer Filho

activity in the Vop and somatic sensory reorganization in the Vim with dystonic patients. Stimulating the Vim in the dystonic group produced muscle activities through these modified sensory maps, whereas in the nondystonic group motor alterations were not produced. 11 In this manner, hyperkinetic presentation is related to GPi and Vop in the cortico-striato-pallido-thalamo-cortical pathway, and hypokinesia with Vim through the cerebello-thalamo-cortical pathway. It helps to explain the lack of response to GPi DBS in hypokinetic patients, 4 , 14 and in those with

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Shigeki Kameyama, Hiroshi Shirozu, Hiroshi Masuda, Yosuke Ito, Masaki Sonoda, and Kohei Akazawa

asymptomatic intracranial hemorrhage (after 4, 2.9%) ( Table 3 ). Although the prevalence of these transient complications was almost equal between the 2 groups, there was a significantly higher prevalence of hyperthermia in the pediatric group (p = 0.002). A higher prevalence of short-term memory disturbance was associated with the cases of bilaterally attached HH. Immediately after 35 SRTs, patients presented with obvious hypotonia, hypokinesia, and dysdiadochokinesis of the contralateral limbs, likely as transient supplementary motor symptoms. Emotional facial paresis

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Juei-Jueng Lin, Ging-Yau Lin, Chunhsi Shih, Shinn-Zong Lin, Dar-Cheng Chang, and Chan-Chian Lee

4 4 total 120 51 37 33.5 33.5 Discussion Stereotactic surgery on the posteroventral portion of the GPi to control parkinsonian symptoms was initiated by Lars Leksell in the 19 50s. 12 However, further development of this approach was halted because of the introduction of medical treatment with levodopa. In the early 1990s, Laitinen and colleagues 8 began to reevaluate the therapeutic effect of pallidotomy in patients with Parkinson's disease (PD). Since then, PVP has been proven to be effective in ameliorating response fluctuations, hypokinesias, rigidity, and