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Seventy Years of Pallidotomy for Movement Disorders
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap. Unit of Functional Neurosurgery, University College London-Institute of Neurology, Queen Square, London, UK.
2017 (Engelska)Ingår i: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 32, nr 7, s. 972-982Artikel i tidskrift, Editorial material (Övrigt vetenskapligt) Published
Abstract [en]

The year 2017 marks the 70th anniversary of the birth of human stereotactic neurosurgery. The first procedure was a pallidotomy for Huntington's disease. However, it was for Parkinson's disease that pallidotomy was soon adopted worldwide. Pallidotomy was abandoned in the late 1950s in favor of thalamotomy because of the latter's more striking effect on tremor. The advent of levodopa put a halt to all surgery for PD. In the mid-1980s, Laitinen reintroduced the posteroventral pallidotomy of Leksell, and this procedure spread worldwide thanks to its efficacy on most parkinsonian symptoms including levodopa-induced dyskinesias and thanks to basic scientific work confirming the role of the globus pallidus internus in the pathophysiology of PD. With the advent of deep brain stimulation of the subthalamic nucleus, pallidotomy was again abandoned, and even DBS of the GPi has been overshadowed by STN DBS. The GPi reemerged in the late 1990s as a major stereotactic target for DBS in dystonia and, recently, in Tourette syndrome. Lately, lesioning of the GPI is being proposed to treat refractory status dystonicus or to treat DBS withdrawal syndrome in PD patients. Hence, the pallidum as a stereotactic target for either lesioning or DBS has been the phoenix of functional stereotactic neurosurgery, constantly abandoned and then rising again from its ashes. This review is a tribute to the pallidum on its 70th anniversary as a surgical target for movement disorders, analyzing its ebbs and flows and highlighting its merits, its versatility, and its resilience.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2017. Vol. 32, nr 7, s. 972-982
Nyckelord [en]
globus pallidus, pallidum, pallidotomy, Parkinson's disease, dystonia, deep brain stimulation
Nationell ämneskategori
Neurologi Medicinsk biovetenskap
Identifikatorer
URN: urn:nbn:se:umu:diva-137964DOI: 10.1002/mds.27054ISI: 000405488300003OAI: oai:DiVA.org:umu-137964DiVA, id: diva2:1129292
Tillgänglig från: 2017-08-02 Skapad: 2017-08-02 Senast uppdaterad: 2018-06-09Bibliografiskt granskad

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Hariz, Marwan

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