Frequency of Improvement in Muscular Rigidity after Pallidotomy in Medically Refractive Parkinsonian Patients

  • IMRAN ALI Department of Neurosurgery Unit II, Punjab Institute of Neuro-Sciences (PINS) Lahore General Hospital, Lahore
  • HASSAAN ZAHID Department of Neurosurgery Unit II, Punjab Institute of Neuro-Sciences (PINS) Lahore General Hospital, Lahore
  • ADEEB -UL-HASSAN Department of Neurosurgery Unit II, Punjab Institute of Neuro-Sciences (PINS) Lahore General Hospital, Lahore
  • KHALID MAHMOOD Department of Neurosurgery Unit II, Punjab Institute of Neuro-Sciences (PINS) Lahore General Hospital, Lahore
Keywords: Parkinson’s disease, dyskinesia, medically refractory,, Urified Paskinsons Disease Rating Score, rigidity

Abstract

Objective: To find out frequency of improvement in muscular rigidity after Pallidotomy in Parkinsonian patients who are medically refractory.
Material and Methods: This prospective descriptive study conducted in Neurosurgical Unit II, Punjab Institute of Neuro-Sciences, LGH, Lahore, during the period of one year from March 2015 to February 2016. They were evaluated before admission by history and thorough examination and then investigated with a CT scan and MRI of the brain. This study included patients as young as 30 years to as old as 65 years. Those patients who had trauma, stroke, demyelination or lesion in basal ganglia were excluded from the study.
Results: 75 patients were included in the study with no lost to follow up. At the time of presentation, baseline rigidity graded as 3 in 37 (49.3%) and grade 4 in 38 (50.67%) patients. Reduction in rigidity at ≥ 25%, was considered significant improvement. At 3 months follow up 49 (65.3%) patients had UPRDS grade 1 while 26 (34.7%) had (Unipied Parkinson’s Disease Rating Score) UPRDSS grade 2 and no patient shown UPRDS grade 3 or 4. Out of 37 patients who had UPRDS grade 3 at baseline, 32 had grade 1 while 5 had grade 2 after Pallidotomy. Out of 38 patients, who had UPRDS grade 4 at baseline, 17 had UPRDS grade 1 while 21 had UPRDS grade 2 after pallidotomy. The difference was calculated to be significantly high (p < 0.001).
Conclusion: Pallidotomy is one of the successful surgical procedures to reduce Parkinsonian muscular rigidity.

References

Damier P, Hirsch EC, Agid Y, Graybiel M. Brain.The substantia nigra of the human brain: II. Patterns of loss of dopamine-containing neurons in Parkinson's disease, 1999, 122 (8): 1437-1448.
2. Ma Y, Stebbins G, Jaffar S, Dopamine transporter immunoreactive neurons decrease with age in human substrantia nigra, Journal of comparative Neurology, 1999; 409 (1).
3. Koller W, Gray C, Alexander C, Environmental risk factors in Parkinson’s disease, 1990; 40 (8).
4. Stephen K, Carolin M, Allan L, incidence of Parkinson’s disease: Variation by age, Gender and Race/Ethnicity, American Journal of Epidmiology, 2003; 157 (11): 1015-1022.
5. Dr Panel K, Scab D, Healy G, Non-motor symptoms of Parkinson’s Disease: diagnosis and management, The Lancet Neurology, 2006;5 (3): 235-245.
6. Caroline M, The Role of environmental toxins in etiology of Parkinson’s Disease, Trends in Neuroscience, 1989; 12 (2): 49-54.
7. Alberto A, Holangi C, Mark G,Pesticide exposure and risk for Parkinson’s disease, Annual of Neurology, 2006;60 (2).
8. Yoshinori H, Robert I,Surgical implications in patients with Parkinson’s disease after Posteroventral Pallidotomy, Neurosurgery, 2003; 52 (3): 558-571.
9. Warren C, Yoshi Mizuno, Bonucelli U, Levodopa in the treatment of Parkinson’s disease: current controversies, Movement disorders, 2004; 19.
10. Lauri V, Laitinen A, Marwan I,Leksell’sPosteroventral pallidotomy in the treatment of Parkinson’s disease, journal of Neurosurgery (JNS), 1992;76 (1).
11. Iacono RP, Shima F, Lonser RR, Maeda G, The results, indications and physiology of Posteroventral pallidotomy for patients with Parkinson’s disease, Neurosurgery, 1988, 36 (6): 1118-1125.
12. Etienne Hirsch, Ann M, Yves A. Melanized dopaminergic neurons are differently susceptible to degenrationin Parkinson’s disease, Nature, 1988; 334: 345-348.
13. Robert E, William T, Paul G. A critical evaluation of the Braak staging scheme for Parkinson’s disease, Annals, of Neurology, 2008; 64 (5).
14. Stephen K, Caroline M, Allan L, Robin D. Incidence of Parkinson’s disease: Variation by age, Gender and Race/ethinicity, American Journal of Epidemiology, 2003; 157 (11): 1015-1022.
15. Mayeux R, Marder K, Jean Denaro, The frequency of idiopathetic Parkinson’s disease by Age, ethenic group and sex in northern Manhattan, Am J epidemiol. 1995; 142: 820-827.
16. Stephen K, Caroline M, Allan L, Robin D, Incidence of Parkinson’s disease: Variation by age, Gender and Race/ethinicity, American Journal of Epidemiology, 2003; 157 (11): 1015-1022.
17. Tanner C, Goldman M, Ruth Ottman, Epidemiology of Parkinson’s disease, Neurol Clin. 1996; 14: 317-335.
18. Green P, Gridly K, Simplins, Neuclear estrogen receptor-independence neuro protection by estratrienes-a noval interaction with glutathione, Neuroscience, 1998; 83: 7-10.
19. Anthony E, The progression of Parkinson’s disease, a hypothesis,Neurology, 2007; 68 (12): 948-952.
20. Anette Scharag, Nial Quinin Brain, Dyskinesia and motor fluctuations in Parkinson’s disease, a community based study, Brain A journal of neurology, 2000; 123 (11): 2297-2305.
21. Marcedes CD, Parkes JD. Success and problems of long term levodopa therapy in Parkinson’s disease, 1977; 309 (8007): 345-349.
22. Richard D, MCDowell FH. Five years treatment of Parkinson’s Disease with Levodopa, therapeutic results and survival of 100 patients, Ann Intern Med. 1975; 83 (4): 456-463.
23. Ronald P, Stanley Fahn, Stuart R, Lucien J. Analysis of clinical problems in Parkinsonism and complications of long term levodopa therapy, Analysis of Neurology, 1979; 29 (9): 1253-1260.
24. Dogali M, Fazzani E, Kolodny E, Stereotactic ventral pallidotomy for Parkinson’s disease, Neurology, 1995; 45 (4): 753-761.
Published
2019-06-04
Section
Original Article