Multi-target strategy for Parkinsonian patients: the role of deep brain stimulation in the centromedian-parafascicularis complex

Brain Res Bull. 2009 Feb 16;78(2-3):113-8. doi: 10.1016/j.brainresbull.2008.08.007. Epub 2008 Sep 21.

Abstract

The intra-laminar (IL) thalamic complex, composed of centromedian (CM) and parafascicular (Pf) nucleus, is a strategic crossroad for the activity of the basal ganglia and is recently regaining its position has a putative neurosurgical target for Parkinsonian syndromes. The multi-target approach we have encouraged since the late nineties has allowed the combined implantation of a standard target (the subthalamic nucleus-STN or the internal pallidus-GPi) plus an innovative one (CM/Pf) in well-identified Parkinson's disease (PD) patients; hence, it is possible to study, in the same PD patients, the specific target-mediated effects on different clinical signs. Here, we focus on the potential usefulness of implanting the CM/Pf complex when required in the management of contra-lateral tremor (resistant to standard deep brain stimulation-DBS - in STN - , n=2) and disabling involuntary movements, partially responsive to GPi-DBS (n=6). When considering global UPDRS scores, CM/Pf-DBS ameliorate extra-pyramidal symptoms but not as strongly as STN (or GPi) does. Yet, CM/Pf acts very powerfully on tremor and contributes to the long-term management of l-Dopa-induced involuntary movements. The lack of cognitive deficits and psychic impairment associated with the improvement of their quality of life, in our small cohort of CM/Pf implanted patients, reinforces the notion of CM/Pf as a safe and attractive area for surgical treatment of advanced PD, possibly affecting not only motor but also associative functions.

MeSH terms

  • Basal Ganglia / pathology
  • Basal Ganglia / physiopathology
  • Basal Ganglia / surgery
  • Cohort Studies
  • Combined Modality Therapy
  • Deep Brain Stimulation / methods*
  • Dyskinesias / etiology
  • Dyskinesias / surgery
  • Dyskinesias / therapy
  • Electrodes, Implanted
  • Female
  • Humans
  • Intralaminar Thalamic Nuclei / pathology
  • Intralaminar Thalamic Nuclei / physiopathology
  • Intralaminar Thalamic Nuclei / surgery*
  • Neurosurgical Procedures / methods
  • Parkinson Disease / diagnosis
  • Parkinson Disease / surgery*
  • Parkinson Disease / therapy*
  • Quality of Life / psychology
  • Treatment Outcome
  • Tremor / etiology
  • Tremor / surgery
  • Tremor / therapy