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L-dopa-induced dyskinesia and stereotactic surgery for Parkinson's disease.
Neurosurgery. 2008 Feb; 62(2):311-23; discussion 323-5.N

Abstract

OBJECTIVE

To assess the impact of different surgical targets and techniques, such as ablation and deep brain stimulation, to treat patients with L-dopa-induced dyskinesia (LID), a major therapeutic complication of Parkinson's disease.

METHODS

This review analyzes the effects of early surgical procedures to treat hyperkinesia and the current methods and targets used to combat LID in Parkinson's disease, which are mainly thalamotomy, pallidotomy, and deep brain stimulation of the globus pallidus internus and the subthalamic nucleus.

RESULTS

Available information indicates that surgery of the globus pallidus internus and thalamus (the pallidal receiving area) and of the subthalamic nucleus has a pronounced antidyskinetic effect. This effect is associated with a concomitant improvement in the parkinsonian ("off"-medication) state. Although it is more profound with pallidal and subthalamic surgery, such an effect can also be observed to some extent with thalamic surgery. The latter is attributable to the fact that surgery of the ventralis intermedius is primarily effective for treating tremor. An integral pallidothalamic pathway is needed for dyskinesia to be expressed. Thus, LID is less frequent after subthalamotomy or deep brain stimulation of the subthalamic nucleus through a functional effect mediated by the physiological normalization of the motor system and by an indirect effect associated with a reduction in the daily dose of L-dopa.

CONCLUSION

Surgery is the only treatment available for Parkinson's disease that can predictably improve both the parkinsonian motor syndrome and LID. The exact mechanisms involved in these effects are not well understood. Pallidal and thalamic surgery affecting pallidal relays reduce LID frequency by disrupting the pallidothalamic circuit, probably eliminating the neuronal activity associated with dyskinesia. Alternatively, the antidyskinetic effect of subthalamic nucleus surgery may in part be attributable to a reduction in the L-dopa dose as well as to the stabilization of the basal ganglia circuits after the surgical procedure.

Authors+Show Affiliations

Division of Neurosurgery, Neuroscience Department, University Clinic, University of Navarra, Pamplona, Spain. jguridi@unav.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18382309

Citation

Guridi, Jorge, et al. "L-dopa-induced Dyskinesia and Stereotactic Surgery for Parkinson's Disease." Neurosurgery, vol. 62, no. 2, 2008, pp. 311-23; discussion 323-5.
Guridi J, Obeso JA, Rodriguez-Oroz MC, et al. L-dopa-induced dyskinesia and stereotactic surgery for Parkinson's disease. Neurosurgery. 2008;62(2):311-23; discussion 323-5.
Guridi, J., Obeso, J. A., Rodriguez-Oroz, M. C., Lozano, A. A., & Manrique, M. (2008). L-dopa-induced dyskinesia and stereotactic surgery for Parkinson's disease. Neurosurgery, 62(2), 311-23; discussion 323-5. https://doi.org/10.1227/01.neu.0000315998.58022.55
Guridi J, et al. L-dopa-induced Dyskinesia and Stereotactic Surgery for Parkinson's Disease. Neurosurgery. 2008;62(2):311-23; discussion 323-5. PubMed PMID: 18382309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - L-dopa-induced dyskinesia and stereotactic surgery for Parkinson's disease. AU - Guridi,Jorge, AU - Obeso,Jose A, AU - Rodriguez-Oroz,Maria C, AU - Lozano,Andres A, AU - Manrique,Miguel, PY - 2008/4/3/pubmed PY - 2008/6/18/medline PY - 2008/4/3/entrez SP - 311-23; discussion 323-5 JF - Neurosurgery JO - Neurosurgery VL - 62 IS - 2 N2 - OBJECTIVE: To assess the impact of different surgical targets and techniques, such as ablation and deep brain stimulation, to treat patients with L-dopa-induced dyskinesia (LID), a major therapeutic complication of Parkinson's disease. METHODS: This review analyzes the effects of early surgical procedures to treat hyperkinesia and the current methods and targets used to combat LID in Parkinson's disease, which are mainly thalamotomy, pallidotomy, and deep brain stimulation of the globus pallidus internus and the subthalamic nucleus. RESULTS: Available information indicates that surgery of the globus pallidus internus and thalamus (the pallidal receiving area) and of the subthalamic nucleus has a pronounced antidyskinetic effect. This effect is associated with a concomitant improvement in the parkinsonian ("off"-medication) state. Although it is more profound with pallidal and subthalamic surgery, such an effect can also be observed to some extent with thalamic surgery. The latter is attributable to the fact that surgery of the ventralis intermedius is primarily effective for treating tremor. An integral pallidothalamic pathway is needed for dyskinesia to be expressed. Thus, LID is less frequent after subthalamotomy or deep brain stimulation of the subthalamic nucleus through a functional effect mediated by the physiological normalization of the motor system and by an indirect effect associated with a reduction in the daily dose of L-dopa. CONCLUSION: Surgery is the only treatment available for Parkinson's disease that can predictably improve both the parkinsonian motor syndrome and LID. The exact mechanisms involved in these effects are not well understood. Pallidal and thalamic surgery affecting pallidal relays reduce LID frequency by disrupting the pallidothalamic circuit, probably eliminating the neuronal activity associated with dyskinesia. Alternatively, the antidyskinetic effect of subthalamic nucleus surgery may in part be attributable to a reduction in the L-dopa dose as well as to the stabilization of the basal ganglia circuits after the surgical procedure. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/18382309/L_dopa_induced_dyskinesia_and_stereotactic_surgery_for_Parkinson's_disease_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/01.neu.0000315998.58022.55 DB - PRIME DP - Unbound Medicine ER -