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Long-term thalamic stimulation in Parkinson's disease

Postmortem anatomoclinical study

Clinique Neurologique (Drs. Caparros-Lefebvre and Petit), Service de Neuropathologie (Dr. Ruchoux), and Département de Neurochirurgie (Dr. Blond), CHRU Lille; and Laboratoire de Neuromorphologie Informationnelle et de Neurologie Expérimental du Mouvement, Hôpital de la Salpêtrière, Paris, France.

Parkinsonian tremor may be suppressed by thalamic stimulation. For an equivalent clinical efficacy, its obvious advantage over micro-thalamotomy is its reversibility. This patient experienced postural tremor at the age of 44 years and akineto-rigid syndrome 8 years later. At the age of 60 years, intrathalamic stimulation was applied over a long-term period of 43 months until death and was efficient on tremor with low stimulation. This case is the first with anatomic verification. The extent of the lesion provoked by the electrode is very small. The location of the stimulation site was in the medio-inferior part of the intermedius complex at the entrance of cerebello-thalamic fibers. The stimulation of the cerebellar afferent axons could be the cause of the clinical effect. The stimulation site corresponds to the thalamic source of the precentral and accessory motor cortex, which correlates with changes observed in our PET study showing a regional cerebral blood flow decrease in cerebellar nuclei and also in precentral and accessory motor cortex. The places and mechanisms of the effects of stimulations and lesions could be different.

Address correspondence and reprint requests to Dr. Dominique Caparros-Lefebvre, Département de Neurologie, CHRU Lille, F-59037 LILLE Cedex, France.

Supported by grants from France-Parkinson Association and Lille University Hospital (CHRU).

Received December 27, 1993. Accepted in final form March 15, 1994.

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