Targeting the subthalamic nucleus in the treatment of Parkinson’s disease

As more is learnt about the functional implications of basal ganglia connectivity, the role of the subthalamic nucleus as a target site for stereotactic procedures in the amelioration of the symptoms of Parkinson’s disease is becoming clearer. A comparison of various neurosurgical procedures in the...

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Bibliographic Details
Published in:Brain Research Bulletin 1998-08, Vol.46 (6), p.467-474
Main Authors: Henderson, J.M, Dunnett, S.B
Format: Article
Language:English
Subjects:
Animals
Biological and medical sciences
Deep-brain Stimulation
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Electric Stimulation
Electric Stimulation Therapy
Globus Pallidus - physiopathology
Globus Pallidus - surgery
Human
Humans
Lesions
Marmoset
Medical sciences
Neurology
Pallidotomy
Parkinson Disease - physiopathology
Parkinson Disease - surgery
Parkinson Disease - therapy
Thalamic Nuclei - physiopathology
Thalamic Nuclei - surgery
Thalamotomy
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Summary:As more is learnt about the functional implications of basal ganglia connectivity, the role of the subthalamic nucleus as a target site for stereotactic procedures in the amelioration of the symptoms of Parkinson’s disease is becoming clearer. A comparison of various neurosurgical procedures in the disease is discussed in relation to current thinking about circuitry. Experimental investigations involving lesioning or stimulation of the subthalamic nucleus in nonhuman primate models and in clinical studies of Parkinson’s disease are compared. Neurosurgical procedures that lesion structures bilaterally are more likely to induce side effects than is deep-brain stimulation, which has the added advantage of reversibility and which is more amenable to titration in relation to medication and dosage. A small but growing number of parkinsonian patients have received subthalamic stimulation either unilaterally or bilaterally. Stimulation of the subthalamic nucleus ameliorates tremor, rigidity and hypokinesia, as opposed to thalamic stimulation which is probably best reserved for tremor-dominant patients. Such procedures also do not involve the same complex technical and ethical issues that are associated with foetal mesencephalic grafting. Although subthalamic stimulation shows great promise, it has not been developed to the point where it can be used as more than an experimental treatment. Further experimental research is required before the new strategies can be used on a larger scale.
ISSN:0361-9230
1873-2747
DOI:10.1016/S0361-9230(97)00449-8