Tremor control after pallidotomy in patients with Parkinson's disease: Correlation with microrecording findings

Jamal M. Taha, Jacques Favre, Thomas K. Baumann, Kim Burchiel

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Abstract

The goals of this study were to analyze the effect of pallidotomy on parkinsonian tremor and to ascertain whether an association exists between microrecording findings and tremor outcome. Forty-four patients with Parkinson's disease who had drug-induced dyskinesia, bradykinesia, rigidity, and tremor underwent posteroventral pallidotomy. Using a 1-μ-tip tungsten electrode, microrecordings were obtained through one to three tracts, starting 10 mm above the pallidal base. Tremor severity was measured on a patient-rated, 100-mm Visual Analog Scale (VAS), both preoperatively and 3 to 9 months (mean 6 months) postoperatively. Preoperatively, tremor was rated as 50 mm or greater in 24 patients (55%) and as less than 25 mm in 13 patients (30%). Postoperatively, tremor was rated as 50 mm or greater in five patients (11%) and less than 25 mm in 29 patients (66%). The difference was significant (p = 0.0001). Four patients (9%) had no postoperative tremor. Tremor improved by at least 50% in eight (80%) of 10 patients in whom tremor- synchronous cells were recorded (Group A) and in 12 (35%) of 34 patients in whom tremor-synchronous cells were not recorded (Group B). This difference was significant (p = 0.03). Tremor improved by at least 50 mm in all (100%) of the seven Group A patients with severe (≤50 mm) preoperative tremor and in nine (53%) of 17 Group B patients with severe preoperative tremor. This difference was also significant (p = 0.05). The authors proffer two conclusions: 1) after pallidotomy, tremor improves by at least 50% in two- thirds of patients with Parkinson's disease who have severe (≤50 mm on the VAS) preoperative tremor; and 2) better tremor control is obtained when tremor-synchronous cells are included in the lesion.

Original languageEnglish (US)
Pages (from-to)642-647
Number of pages6
JournalJournal of Neurosurgery
Volume86
Issue number4
StatePublished - Apr 1997

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Pallidotomy
Tremor
Parkinson Disease
Visual Analog Scale
Drug-Induced Dyskinesia

Keywords

  • microrecording
  • pallidotomy
  • Parkinson's disease
  • tremor

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Tremor control after pallidotomy in patients with Parkinson's disease : Correlation with microrecording findings. / Taha, Jamal M.; Favre, Jacques; Baumann, Thomas K.; Burchiel, Kim.

In: Journal of Neurosurgery, Vol. 86, No. 4, 04.1997, p. 642-647.

Research output: Contribution to journalArticle

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abstract = "The goals of this study were to analyze the effect of pallidotomy on parkinsonian tremor and to ascertain whether an association exists between microrecording findings and tremor outcome. Forty-four patients with Parkinson's disease who had drug-induced dyskinesia, bradykinesia, rigidity, and tremor underwent posteroventral pallidotomy. Using a 1-μ-tip tungsten electrode, microrecordings were obtained through one to three tracts, starting 10 mm above the pallidal base. Tremor severity was measured on a patient-rated, 100-mm Visual Analog Scale (VAS), both preoperatively and 3 to 9 months (mean 6 months) postoperatively. Preoperatively, tremor was rated as 50 mm or greater in 24 patients (55{\%}) and as less than 25 mm in 13 patients (30{\%}). Postoperatively, tremor was rated as 50 mm or greater in five patients (11{\%}) and less than 25 mm in 29 patients (66{\%}). The difference was significant (p = 0.0001). Four patients (9{\%}) had no postoperative tremor. Tremor improved by at least 50{\%} in eight (80{\%}) of 10 patients in whom tremor- synchronous cells were recorded (Group A) and in 12 (35{\%}) of 34 patients in whom tremor-synchronous cells were not recorded (Group B). This difference was significant (p = 0.03). Tremor improved by at least 50 mm in all (100{\%}) of the seven Group A patients with severe (≤50 mm) preoperative tremor and in nine (53{\%}) of 17 Group B patients with severe preoperative tremor. This difference was also significant (p = 0.05). The authors proffer two conclusions: 1) after pallidotomy, tremor improves by at least 50{\%} in two- thirds of patients with Parkinson's disease who have severe (≤50 mm on the VAS) preoperative tremor; and 2) better tremor control is obtained when tremor-synchronous cells are included in the lesion.",
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