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Volker M. Tronnier and Wolfgang Fogel

. 2–4, 5, 13, 21 However, it was found that thalamotomy mainly improves distal limb dystonia without major effects on truncal or axial symptoms. Recent reports of pallidotomy describe a marked effect on all dystonic symptoms, including speech, writing ability, and gait. 11, 16–18, 25, 26 Bilateral pallidal stimulation is an attractive alternative to pallidotomy in Parkinson's disease according to some authors, 20, 27 although others could not confirm these results 10, 22, 24 and favor other targets such as the subthalamic nucleus. However, in generalized primary

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Dipankar Nandi, Simon Parkin, Richard Scott, Jonathan L. Winter, Carole Joint, Ralph Gregory, John Stein, and Tipu Z. Aziz

flare. The electrodes are straddling the GPi, one on each side. Postoperative Clinical Assessment After 1 month of long-term pallidal stimulation, the patient no longer suffered from sudden spasms of truncal flexure, allowing him to eat in a normal position. At the latest follow-up examination, 6 months postoperatively, he was able to stand normally ( Fig. 3 upper ) and walk in an upright position for approximately 50 ft. He was far more independent and was able to go to places such as the local pub and shops, with minimal use of a cane. In addition

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Volker M. Tronnier, Wolfgang Fogel, Martin Kronenbuerger, and Sarah Steinvorth

-resistant parkinsonian tremor has been replaced in many neurosurgical centers by stimulation of the nucleus ventralis intermedius (VIM), as introduced by Benabid, Siegfried, and others, 2, 9, 10, 13, 60, 61 bilateral pallidal stimulation is still considered an experimental procedure by many neurologists and neurosurgeons. Given the low morbidity rates engendered by stimulation procedures compared with lesioning methods, especially bilateral procedures, 14, 31, 67 the benefits of this new method should be evaluated. There was an initially encouraging paper 60 published in 1994

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Dipankar Nandi, Simon Parkin, Richard Scott, Jonathan L. Winter, Carole Joint, Ralph Gregory, John Stein, and Tipu Z. Aziz

The authors report the neurological, neurophysiological, and neuropsychological effects of using chronic bilateral pallidal high-frequency deep brain stimulation (DBS) in a case of disabling camptocormia.

Deep brain stimulation electrodes were implanted stereotactically to target the globus pallidus internus (GPi) bilaterally. Local field potentials (FPs) were recorded using the DBS electrodes and concurrent abdominal flexor elec-tromyography (EMG) potentials during camptocormic episodes. Videotaped assessments of the movement disorder and neuropsychological evaluation before implantation and at 6 months after initiation of pallidal stimulation were recorded.

There was significant functional improvement following chronic pallidal stimulation, and some improvement was noted in neuropsychological scores. The GPi FPs showed temporal correlation with EMG-recorded rectus abdominis potentials. There were no treatment-related adverse effects.

The authors have found that chronic pallidal stimulation was safe and offered functional benefit in this severely disabling condition. The physiological studies may help further the understanding of the pathophysiology of this rare entity.

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Veerle Visser-Vandewalle, Chris van der Linden, Yasin Temel, Fred Nieman, Halime Celik, and Emile Beuls

parkinsonian symptoms 7, 8, 23, 24 and because DBS had proved to have fewer complications, 35 we decided to start with unilateral pallidal stimulation in selected patients. In previous studies we reported on cognitive outcomes 41 and changes in the quality of life 40 following unilateral pallidal stimulation in patients with PD. In this report we prospectively analyze the long-term effects of unilateral pallidal stimulation on motor function. Clinical Material and Methods Patient Population Between January 1996 and June 1997 patients were selected for

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Volker M. Tronnier, Wolfgang Fogel, Martin Kronenbuerger, and Sarah Steinvorth

A resurgence of interest in the surgical treatment of Parkinson's disease (PD) came with the rediscovery of posteroventral pallidotomy by Laitinen in 1985. Laitinen's procedure improved most symptoms in drug-resistant PD, which engendered wide interest in the neurosurgical community. Another lesioning procedure, ventrolateral thalamotomy, has become a powerful alternative to stimulate the nucleus ventralis intermedius, producing high long-term success rates and low morbidity rates. Pallidal stimulation has not met with the same success. According to the literature pallidotomy improves the “on” symptoms of PD, such as dyskinesias, as well as the “off” symptoms, such as rigidity, bradykinesia, and on-off fluctuations. Pallidal stimulation improves bradykinesia and rigidity to a minor extent; however, its strength seems to be in improving levodopa-induced dyskinesias. Stimulation often produces an improvement in the hyper- or dyskinetic upper limbs, but increases the “freezing” phenomenon in the lower limbs at the same time. Considering the small increase in the patient's independence, the high costs of bilateral implants, and the difficulty most patients experience in handling the devices, the question arises as to whether bilateral pallidal stimulation is a real alternative to pallidotomy.

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Shouyan Wang, Xuguang Liu, John Yianni, Alex L. Green, Carole Joint, John F. Stein, Peter G. Bain, Ralph Gregory, and Tipu Z. Aziz

to elucidate its underlying mechanisms. 1 , 8 , 12 , 14 , 20 We still lack clinical methods for predicting the variable outcomes in pallidal stimulation, which has limited the procedure’s clinical application for dystonia. 6 Patients with primary dystonia seem to respond well to pallidal surgery, whereas those with secondary dystonia have a more varied outcome. 10 Those with DYT1 mutations appear to respond best to pallidal stimulation, 9 , 18 although data are notably inconsistent among the different studies. 5 , 9 , 10 , 18 , 19 Clinically, among patients

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Joseph Ghika, Jean-Guy Villemure, Heinz Fankhauser, Jacques Favre, Gil Assal, and Florence Ghika-Schmid

, 51 We report our experience in six patients who underwent bilateral contemporaneous pallidal stimulation with a minimum follow-up period of 24 months. Clinical Material and Methods Six nondemented patients who suffered from levodoparesponsive parkinsonism with severe untreatable motor fluctuations, a mean “on/off” Hoehn and Yahr stage score of 3/4.2, and a mean duration of disease of 15 years ( Table 1 ) underwent bilateral contemporaneous pallidal stimulation, which was performed by one of two authors (J.G.V. and H.F.). A seventh patient was also recruited

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Angelo Franzini, Carlo Marras, Paolo Ferroli, Giovanna Zorzi, Orso Bugiani, Luigi Romito, and Giovanni Broggi

and resistant to any pharmacological treatment, including benzodiazepines and botulinum toxin injections. In this report we describe two cases of tardive dystonia in which long-term bilateral high-frequency pallidal stimulation was used as a therapeutic intervention. We report that there was a dramatic, long-lasting improvement in each of these cases. Case Report Preoperative Case Summaries Case 1 This 33-year-old man, who was 16 years of age when schizophrenia was diagnosed, had no family history of neurological disease or movement disorders and had

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Yasushi Miyagi and Yu Koike

, Heinen F : Bilateral pallidal stimulation in children and adolescents with primary generalized dystonia—report of six patients and literature-based analysis of predictive outcomes variables . Brain Dev 32 : 223 – 228 , 2010 6 Bronte-Stewart H , Taira T , Valldeoriola F , Merello M , Marks WJ Jr , Albanese A , : Inclusion and exclusion criteria for DBS in dystonia . Mov Disord 26 : Suppl 1 S5 – S16 , 2011 7 Cersosimo MG , Raina GB , Piedimonte F , Antico J , Graff P , Micheli FE : Pallidal surgery for the treatment