Neuropsychological outcome of GPi pallidotomy and GPi or STN deep brain stimulation in Parkinson's disease

被引:182
|
作者
Trépanier, LL
Kumar, R
Lozano, AM
Lang, AE
Saint-Cyr, JA
机构
[1] Toronto Hosp, Western Div, Ctr Movement Disorders, Toronto, ON M5T 2S8, Canada
[2] Toronto Western Hosp, Inst Res, Toronto, ON M5T 2S8, Canada
[3] Univ Toronto, Div Neurosurg, Dept Surg, Toronto, ON, Canada
[4] Univ Toronto, Dept Med, Div Neurol, Toronto, ON, Canada
[5] Toronto Hosp, Morton & Gloria Shulman Movement Disorder Ctr, Toronto, ON M5T 2S8, Canada
[6] York Univ, Dept Psychol, N York, ON M3J 1P3, Canada
[7] Univ Toronto, Dept Psychol, Toronto, ON M5S 1A1, Canada
关键词
neuropsychology; Parkinson's disease; pallidotomy; deep brain stimulation; basal ganglia; subthalamic nucleus; globus pallidus;
D O I
10.1006/brcg.1999.1108
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
This paper highlights the neuropsychological sequelae of posteroventral pallidotomy (PVP) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the internal segment of the globus pallidus (GPi) at 3/6 months postoperatively. Results are based on our extensive experience with PVP and our preliminary observations with DBS. Patients with borderline cognitive or psychiatric functioning risk postoperative decompensation. Nonlateralizing attentional and hemisphere-specific impairments of frontostriatal cognitive functions followed unilateral PVP. "Frontal" behavioral dyscontrol was observed in approximately 25% of patients. Three cases of staged bilateral PVP suggest that premorbid factors may predict outcome, although lesion size and location are also critical. Older patients are at risk for significant cognitive and behavioral decline after bilateral STN DBS, while GPi DBS may be safer. (C) 2000 Academic Press.
引用
收藏
页码:324 / 347
页数:24
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