Intraoperative dopamine release during globus pallidus internus stimulation in Parkinson's disease

Authors

  • Raquel C.R. Martinez PhD,

    1. Laboratory of Neuromodulation and Experimental Pain, São Paulo, Brazil
    2. University of São Paulo and Institute of Neuroscience and Behavior (INeC), Ribeirao Preto, Brazil
    3. Department of Neurology, Division of Functional Neurosurgery; Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
    4. Department of Surgery, Discipline of Surgical Technique, School of Medicine, University of São Paulo, São Paulo, Brazil
    Search for more papers by this author
  • Clement Hamani MD, PhD,

    1. Department of Neurology, Division of Functional Neurosurgery; Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
    Search for more papers by this author
  • Milene Cristina de Carvalho PhD,

    1. University of São Paulo and Institute of Neuroscience and Behavior (INeC), Ribeirao Preto, Brazil
    Search for more papers by this author
  • Amanda Ribeiro de Oliveira PhD,

    1. University of São Paulo and Institute of Neuroscience and Behavior (INeC), Ribeirao Preto, Brazil
    Search for more papers by this author
  • Eduardo Alho MD, PhD,

    1. Labor für Morphologische Hirnforschung (Laboratory for Morphological Brain Research), Julius-Maximilians Universität Würzburg, Würzburg, Germany
    Search for more papers by this author
  • Jessie Navarro MD,

    1. Department of Neurology, Division of Functional Neurosurgery; Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
    Search for more papers by this author
  • Maria Gabriela dos Santos Ghilardi PhD,

    1. Department of Neurology, Division of Functional Neurosurgery; Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
    Search for more papers by this author
  • Edson Bor-Seng-Shu MD, PhD,

    1. Department of Neurology, Division of Functional Neurosurgery; Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
    Search for more papers by this author
  • Helmut Heinsen PhD,

    1. Labor für Morphologische Hirnforschung (Laboratory for Morphological Brain Research), Julius-Maximilians Universität Würzburg, Würzburg, Germany
    Search for more papers by this author
  • José Pinhata Otoch MD, PhD,

    1. Department of Surgery, Discipline of Surgical Technique, School of Medicine, University of São Paulo, São Paulo, Brazil
    Search for more papers by this author
  • Marcus Lira Brandão MD, PhD,

    1. University of São Paulo and Institute of Neuroscience and Behavior (INeC), Ribeirao Preto, Brazil
    Search for more papers by this author
  • Egberto Reis Barbosa MD, PhD,

    1. Department of Neurology, Division of Functional Neurosurgery; Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
    Search for more papers by this author
  • Manoel Jacobsen Teixeira MD, PhD,

    1. Department of Neurology, Division of Functional Neurosurgery; Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
    2. Department of Surgery, Discipline of Surgical Technique, School of Medicine, University of São Paulo, São Paulo, Brazil
    Search for more papers by this author
  • Erich Talamoni Fonoff MD, PhD

    Corresponding author
    1. Department of Neurology, Division of Functional Neurosurgery; Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
    2. Department of Surgery, Discipline of Surgical Technique, School of Medicine, University of São Paulo, São Paulo, Brazil
    • Correspondence to: Dr. Erich Talamoni Fonoff, Division of Functional Neurosurgery, Department of Neurology, University of São Paulo School of Medicine, Ovídeo Pires de Campos 785, São Paulo 01231-000, Brazil; fonoffet@usp.br

    Search for more papers by this author

  • Funding agencies: Support was provided by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; grant nos. 11/08575-7, 12/06825-9, 11/00041-3 and 10/50669-6), Conselho Nacional de Desenvolvimento. (CNPq 471325/2011-2) and CAPES (project Grant 23038.027765/2009-10; Aux-PE-PNPD 2193/2009).

  • Relevant conflicts of interest/financial disclosures: C.H. is a consultant for St Jude Medical.

  • Full financial disclosure and author roles may be found in the online version of this article

ABSTRACT

Background

It is still unclear whether dopamine (DA) levels correlate with Parkinson's disease (PD) severity or play a role in the mechanisms of high-frequency stimulation (HFS).

Methods

We have used microdialysis to record pallidal DA in 5 patients with PD undergoing microelectrode-guided pallidotomy.

Results

We found that patients with more severe disease and, consequently, lower pallidal DA did poorly after pallidal lesions. In the operating room, 4 of 5 patients had a significant increase in DA levels during HFS (600%, on average). To test the hypothesis that DA was important for the effects of stimulation, we correlated the amelioration in rigidity observed in the operating room with pallidal DA release. Though rigidity was 56% better during stimulation, no correlation was found between such an improvement and DA release.

Conclusions

These findings suggest that additional mechanisms not directly dependent on pallidal DA release may be involved in the clinical effects of HFS of the globus pallidus internus. © 2013 International Parkinson and Movement Disorder Society

Ancillary