ABSTRACT
The goal of the study was to explore the immediate effects of unilateral posteroventral stereotactic pallidotomy (PVP) on psychomotor and executive functioning in patients with Parkinson's disease (PD). The original drawing task, conducted on a digitizing tablet, and neuropsychological tests were administered to 25 patients with PD, 2 or 3 days before and after the surgery. To assess executive functions, the following tests were used: Trail Making Test (TMT), Stroop Colour Interference Test and Wisconsin Card Sorting Test (WCST). To evaluate global mental functioning, Mini Mental State Examination (MMSE) was applied. Benton Visual Retention Test (BVRT) was introduced as a control non-executive task. The patients undergoing a surgery were compared with age and education matched healthy and PD controls. PVP resulted in an increased movability of the upper contralateral limbs reflected in larger average pressure put during the drawing task after the surgery. Assessment of the emotional state showed a significant postoperative improvement. An isolated significant decline of WCST performance, not related to the side of the lesion, was observed immediately after the surgery. The performance of the other executive and non-executive tasks remained unchanged. The results showed that unilateral PVP may lead to immediate selective executive impairment and is needed to be explored in further studies.
Subject(s)
Functional Laterality , Pallidotomy/methods , Parkinson Disease/surgery , Problem Solving/physiology , Psychomotor Performance/physiology , Aged , Analysis of Variance , Case-Control Studies , Female , Humans , Male , Mental Status Schedule , Middle Aged , Neuropsychological Tests/statistics & numerical data , Parkinson Disease/pathology , Parkinson Disease/physiopathologyABSTRACT
BACKGROUND AND PURPOSE: The goal of the study was to assess the results of the stereotactic pallidotomy and thalamotomy in the treatment of primary dystonia. MATERIAL AND METHODS: Thirty patients with primary dystonia underwent twenty-eight stereotactic pallidotomies and twenty two thalamotomies. The operations were based on the fused images of computed tomography and magnetic resonance imaging, and were verified by an intraoperative neurophysiological investigation. Neurological and neuropsychological assessments were performed before surgery and at 3 days, 3 and 6 months after the operation. The Mann-Whitney U test was used to find out statistic differences between subgroups and the Wilcoxon test to compare results between particular assessments. RESULTS: The statistic analysis showed postsurgical amelioration of the neurological state lasting at least 6 months. A better long-term outcome was revealed in the subgroup of pallidotomies vs. thalamotomies, in the subgroup with the onset of dystonia after the age of 35 vs. earlier onset, and in the subgroup of the focal and local dystonia vs. generalized dystonia. The statistically significant improvement was achieved at a depression level and the statistically significant deterioration was not stated in the mental status after the operations. A very low percentage of neurological complications after the operations was found in the study. CONCLUSIONS: The stereotactic pallidotomies and thalamotomies are effective and safe options in the treatment of the intractable cases of primary dystonia. Both resulted predominantly in contralateral improvement of motor functions. However, the results of pallidotomies are better than thalamotomies six months after the surgery. The improvement of the mood without cognitive deterioration was revealed in the neuropsychological tests after the operations. Only few, persistent and mild complications were ascertained in the study.
Subject(s)
Dystonic Disorders/surgery , Pallidotomy/methods , Thalamus/surgery , Adult , Dystonic Disorders/complications , Dystonic Disorders/diagnosis , Female , Humans , Magnetic Resonance Imaging , Male , Monitoring, Intraoperative , Mood Disorders/diagnosis , Mood Disorders/etiology , Mood Disorders/prevention & control , Neuropsychological Tests , Stereotaxic Techniques , Thalamus/diagnostic imaging , Thalamus/pathology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Motor cortex stimulation (MCS) is one of the methods of treatment in chronic pain syndromes. According to recent clinical studies effectiveness of this mode of treatment in the central pain has been proved. This article reports the first case of a patient with the thalamic syndrome treated with MCS in the Clinical Department of Neurosurgery in Military Clinical Hospital in Bydgoszcz. The procedure of implantation was performed with the guidance of a frameless neuronavigation system which served for localization of the precentral gyrus. Correct placement of the electrode was confirmed by intraoperative stimulation. As a result of the treatment a decrease of pain and improvement of psychosocial state has been achieved.
Subject(s)
Deep Brain Stimulation , Motor Cortex/diagnostic imaging , Pain Management , Chronic Disease , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Motor Cortex/pathology , Pain/etiology , Radiography , Syndrome , Thalamic Diseases/complicationsABSTRACT
BACKGROUND AND PURPOSE: The newest studies notify that globus pallidus, besides the motor control, plays an important role in cognitive functioning of: memory, attention, linguistic skills, visuospatial ability, and executive functions. Stereotactic pallidotomy (the lesion of the motor region of the globus pallidus) is one of the surgery options that is used in the treatment of the primary dystonia. Motor region is located in the postero-ventral part of the internal globus pallidus. The goal of the study was to assess of the influence of pallidotomy on cognitive functioning in the group of patients suffering from the primary dystonia. MATERIAL AND METHODS: Eighteen patients diagnosed with primary dystonia were treated by stereotactic pallidotomy and they were investigated neuropsychologically. The study was performed between March 2004 and February 2005. Neuropsychological assessment was conducted 1-2 days prior to operation and 2 days following the surgery. The clinical course of the cognitive functions and emotional status were assessed by the following neuropsychological tests: Mini Mental State Examination (MMSE), Trail Making Test A and B (TMT A and B), Stroop Color-Word Interference Test, N-back Test, Auditory Verbal Learning Test (AVLT), Benton Visual Retention Test (BVRT), Wisconsin Card Sorting Test (WCST), Beck Depression Inventory (BDI), Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: The statistically significant differences have been obtained between the results before and after the surgery in the depression scales: BDI (p<0.02) and in MADRS (p<0.01). None of the neuropsychological tests revealed significant differences between the results before and after the surgery. The only trend (p=0.06-0.07) was noted between results of AVLT before and after the surgery. The average results were worse after the surgery in the first, fifth and sixth attempt of the reply. CONCLUSIONS: Stereotactic pallidotomy has not significantly changed cognitive functions in the patients suffering from primary dystonia. Whereas, the emotional state has significantly improved in consequence of the applying surgery. Stereotactic pallidotomy in primary dystonia seems to be a treatment option safe for the patients' cognitive functions.
