Pallidotomy for hemiballismus: Efficacy and characteristics of neuronal activity
J. I. Suarez MD
Department of Neurology, Johns Hopkins University, Baltimore, Bethsda, MD
Search for more papers by this authorL. Verhagen Metman MD
Experimental Therapeutics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
Search for more papers by this authorS. G. Reich MD
Department of Neurology, Johns Hopkins University, Baltimore, Bethsda, MD
Search for more papers by this authorP. M. Dougherty PhD
Department of Neurosurgery, Johns Hopkins University, Baltimore, Bethsda, MD
Search for more papers by this authorM. Hallet MD
Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
Search for more papers by this authorCorresponding Author
Dr. F. A. Lenz MD, PhD
Department of Neurosurgery, Johns Hopkins University, Baltimore, Bethsda, MD
Department of Neurosurgery, Meyer Building 7-113, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-7713Search for more papers by this authorJ. I. Suarez MD
Department of Neurology, Johns Hopkins University, Baltimore, Bethsda, MD
Search for more papers by this authorL. Verhagen Metman MD
Experimental Therapeutics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
Search for more papers by this authorS. G. Reich MD
Department of Neurology, Johns Hopkins University, Baltimore, Bethsda, MD
Search for more papers by this authorP. M. Dougherty PhD
Department of Neurosurgery, Johns Hopkins University, Baltimore, Bethsda, MD
Search for more papers by this authorM. Hallet MD
Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
Search for more papers by this authorCorresponding Author
Dr. F. A. Lenz MD, PhD
Department of Neurosurgery, Johns Hopkins University, Baltimore, Bethsda, MD
Department of Neurosurgery, Meyer Building 7-113, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-7713Search for more papers by this authorAbstract
A patient with unremitting, medically intractable hemiballismus underwent a pallidotomy that abolished his involuntary movements. Firing rates of cells in the internal segment of the globus pallidus (GPi) recorded during this procedure were significantly lower than those observed during pallidotomy for Parkinson's disease, either “on” or “off” medication. Firing patterns in hemiballismus were characterized by low-frequency modulation of the firing rate. These results are consistent with the hyperkinetic model, which suggests that hemiballismus results from decreased inhibition of the pallidal relay nucleus of the thalamus by the GPi. The efficacy of surgery in the case of hemiballismus demonstrates that pallidotomy can be an effective treatment for this condition and suggests that patterned neuronal activity in the GPi is important in the mechanism of hyperkinetic disorders.
References
- 1 Lang AE, Weiner WJ. Movement disorders: a comprehensive survey. Mount Kisco, NY: Futura Publishing, 1989
- 2 DeLong MR. Primate models of movement disorders of basal ganglia origin. Trends Neurosci 1990; 13: 281–285
- 3 Albin RL, Young A, Penney JB. The functional anatomy of basal ganglia disorders. Trends Neurosci 1989; 12: 366–375
- 4 Carpenter MB, Brittin GM. Subthalamic hyperkinesia in rhesus monkey. J Neurophysiol 1958; 21: 400–412
- 5 Vitek JL, Kaneoke Y, Hashimoto T, et al. Neuronal activity in the pallidum of a patient with hemiballismus. Neurology 1995; 38: 296 (Abstract)
- 6 Stibe CMH, Lees AJ, Kempster PA, Stern GM. Subcutaneous apomorphine in parkinsonian on-off oscillations. Lancet 1988; 1: 403–406
- 7 Mandir AS, Rowland LH, Dougherty PM, Lenz FA. Microelectrode recording and stimulation techniques during stereotactic procedures in the thalamus and pallidum.Adv Neurol 1997 (In press)
- 8 Laitinen LV, Bergenheim AT, Hariz Marwan I. Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 1992; 76: 53–61
- 9 DeLong MR. Activity of pallidal neurons during movement. J Neurophysiol 1971; 34: 414–427
- 10 Lozano AM, Hutchinson W, Kiss Z, et al. Methods for microelectrode guided posteroventral pallidotomy. J Neurosurg 1996; 84: 194–202
- 11 Hutchinson WD, Lozano AM, Davis KD, et al. Differential neuronal activity in segments of the globus pallidus in patients with Parkinson's disease. Neuroreport 1994; 5: 1533–1537
- 12 Lenz FA, Kwan HC, Martin R, et al. Characteristics of somatotopic organization and spontaneous neuronal activity in the region of the thalamic principal sensory nucleus in patients with spinal cord transection. J Neurophysiol 1994; 72: 1570–1587
- 13 Graybiel AM. Neurotransmitters and neuromodulators in the basal ganglia. Trends Neurosci 1990; 13: 244–254
- 14 Carpenter MB, Whittier JR, Mettler FA. Analysis of choreoid hyperkinesia in the rhesus monkey surgical and pharmacological analysis of hyperkinesia resulting from lesions in the subthalamic nucleus of Luys. J Comp Neurol 1950; 92: 293–332
- 15 Cardoso F, Jankovic J, Grossman RG, Hamilton W. Outcome after stereotactic thalamotomy for dystonia and hemiballismus. Neurosurgery 1995; 36: 501–508
- 16 Sterio D, Beric A, Dogali M, et al. Neurophysiological properties of pallidal neurons in Parkinson's disease. Ann Neurol 1994; 35: 586–591
- 17 Vitek JL, Kaneoke Y, Turner R, et al. Neuronal activity in the internal (GPi) and external (GPe) segments of the globus pallidus (GP) of parkinsonian patients is similar to that in the MPTP-treated primate model of parkinsonism. Soc Neurosci Abstr 1993; 19: 1584 (Abstract)
- 18 Filion M, Tremblay L. Abnormal spontaneous activity of globus pallidus neurons in monkeys with MPTP-induced parkinsonism. Brain Res 1991; 547: 142–151
- 19 Matsumura M, Tremblay L, Richard H, Filion M. Activity of pallidal neurons in the monkey during dyskinesia induced by injection of bicuculline in the external pallidum. Neuroscience 1994; 59–70
- 20 Filion M, Tremblay L, Bedard PJ. Effects of dopamine agonists on spontaneous activity of globus pallidus neurons in monkeys with MPTP induced parkinsonism. Brain Res 1991; 547: 152–161
- 21 Penney JB, Young AB. GABA as the pallidothalamic neurotransmitter: implications for basal ganglia function. Brain Res 1981; 207: 195–199
- 22 Inase M, Buford JA, Anderson ME. Changes in the control of arm position, movement, and thalamic discharge during local inactivation in the globus pallidus of the monkey. J Neurophysiol 1996; 75: 1087–1104
- 23 Bromberg MD, Penney JB, Stephenson BS, Young AB. Evidence for glutamate as the neurotransmitter of corticothalamic and corticorubral pathways. Brain Res 1981; 214: 369–374
- 24 Nini A, Fiengold A, Slovin H, Bergman H. Neurons in the globus pallidus do not show correlated activity in the normal monkey but phase-locked oscillations appear in the MPTP model of parkinsonism. J Neurophysiol 1995; 74: 1800–1805
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