Brain, Vol. 122, No. 2, 315-327,
February 1999
© 1999 Oxford University Press
The effects of posteroventral pallidotomy on the preparation and execution of voluntary hand and arm movements in Parkinson's disease
1 MRC Human Movement and Balance Unit, 2 Department of Clinical Neurology and 3 Department of Neurosurgery, Institute of Neurology, London, UK and 4 Functional Neurology and Neurosurgery Center, Clinica Quiron, San Sebastian, Spain
Correspondence to:
P. Limousin, MRC Human Movement and Balance Unit, Institute of Neurology, University College London, 23 Queen Square, London WC1 N3BG, UK
We studied the effect of posteroventral pallidotomy on movement preparation and execution in 27 parkinsonian patients using various motor tasks. Patients were evaluated after overnight withdrawal of medication before and 3 months after unilateral pallidotomy. Surgery had no effect on initiation time in unwarned simple and choice reaction time tasks, whereas movement time measured during the same tasks was improved for the contralesional hand. Movement times also improved for isometric and isotonic ballistic movements. In contrast, repetitive, distal and fine movements measured in finger-tapping and pegboard tasks were not improved after pallidotomy. Preparatory processes were investigated using both behavioural and electrophysiological measures. A precued choice reaction time task suggested an enhancement of motor preparation for the contralesional hand. Similarly, movement-related cortical potentials showed an increase in the slope of the late component (NS2) when the patients performed joystick movements with the contralesional hand. However, no significant change was found for the early component (NS1) or when the patient moved the ipsilesional hand. The amplitude of the long-latency stretch reflex of the contralesional hand decreased after surgery. In summary, the data suggest that pallidotomy improved mainly the later stages of movement preparation and the execution of proximal movements with the contralesional limb. These results provide detailed quantitative data on the impact of posteroventral pallidotomy on previously described measures of upper limb akinesia in Parkinson's disease.
Parkinson's disease; pallidotomy; motor function
CRT = choice/complex reaction time; IT = initiation time; MRCP = motor-related cortical potential; MT = movement time; pcCRT = precued complex reaction time; SMA = supplementary motor area; SRT = simple reaction time
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