Globus pallidus internus pallidotomy for generalized dystonia

Authors

  • Dr. Andres M. Lozano,

    Corresponding author
    1. Division of Neurosurgery and Departments of Surgery, The University of Toronto and The Toronto Hospital Neuroscience Centre, Toronto, Canada
    • Division of Neurosurgery, University of Toronto, The Toronto Hospital, Western Division, 399 Bathrust St., Toronto, Ontario, M5T 2S8, Canada
    Search for more papers by this author
  • R. Kumar,

    1. Division of Neurology and Departments of Medicine, The University of Toronto and The Toronto Hospital Neuroscience Centre, Toronto, Canada
    Search for more papers by this author
  • R. E. Gross,

    1. Division of Neurosurgery and Departments of Surgery, The University of Toronto and The Toronto Hospital Neuroscience Centre, Toronto, Canada
    Search for more papers by this author
  • N. Giladi,

    1. Movement Disorder Centre, Ichilov Hospital Tel Aviv, Israel
    Search for more papers by this author
  • W. D. Hutchison,

    1. Division of Neurosurgery and Departments of Surgery, The University of Toronto and The Toronto Hospital Neuroscience Centre, Toronto, Canada
    Search for more papers by this author
  • J. O. Dostrovsky,

    1. Departments of Physiology, The University of Toronto and The Toronto Hospital Neuroscience Centre, Toronto, Canada
    Search for more papers by this author
  • Anthony E. Lang

    1. Division of Neurology and Departments of Medicine, The University of Toronto and The Toronto Hospital Neuroscience Centre, Toronto, Canada
    Search for more papers by this author

Abstract

The authors present a young boy with severe generalized dystonia treated with bilateral simultaneous pallidotomy. Microelectrode recordings with the patient under propofol anesthesia showed that the mean discharge rate of globus pallidus internus (GPi) neurons was between 21 and 31 Hz. This contracts sharply with the mean GPi neuronal firing rates of approximately 80 Hz that are characteristic of Parkinson's disease. The patient had no immediate benefit from surgery, but a progressive improvement in both axial and limb dystonia began within 3 days. The Burke-Fahn-Marsden scores were 75 (maximum possible = 120) at baseline, 52 at 5 days, and 16 at 3 months after surgery. The mechanism of action of pallidotoy for dystonia and the reasons for the delayed and progressive improvement are unknown. Nevertheless, the magnitude of the improvement and the safety of the procedure in this one patient warrant a careful evaluation of pallidotomy for dystonia.

Ancillary