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Brain, Vol. 125, No. 3, 562-574, March 2002
© 2002 Guarantors of Brain

Global attentional–executive sequelae following surgical lesions to globus pallidus interna

Richard B. Scott1,2,3,6, John Harrison5, Charlotte Boulton1,3, Joanna Wilson1,3, Ralph Gregory2, Simon Parkin2, Peter G. Bain6, Carol Joint2,3, John Stein2,4 and Tipu Z. Aziz2,3,4,6

1 Russell Cairns Unit, 2 Oxford Movement Disorder Group, 3 Department of Neurological Surgery, Radcliffe Infirmary, 4 University Laboratory of Physiology, Oxford University, Oxford, 5 Cambridge Psychometric Consultants, Ely and 6 West London Neurosciences Centre, Charing Cross Hospital, London, UK

Correspondence to: Dr Richard B. Scott, Russell-Cairns Unit, Neurosciences Directorate, Radcliffe Infirmary, Oxford OX2 6HE, UK E-mail: rbs{at}neuropsyche.net

It has been demonstrated that selective unilateral surgical ablation of posteroventral globus pallidus interna relieves the movement disorders associated with advanced Parkinson’s disease, without necessarily incurring the executive cognitive sequelae that have been observed following gross pathological lesions to this brain region. This finding is consistent with established theory that underlying neuronal circuitry is functionally segregated into parallel cortico-striatal-pallidal-thalamo-cortical ‘loops’. We have studied a series of 12 patients with advanced Parkinson’s disease at baseline, and then following bilateral pallidotomy, with a battery of neuropsychological tests including the Cambridge Neuro psychological Test Automated Battery. We identified a selective and universal loss of individual patients’ ability to shift attention to novel dimensions in a test of abstract rule-learning following surgery, which was not reliably associated with any other change in cognition, personality, mood or medication. This finding is rare in its specificity and has implications for theoretical models of the functional architecture and pathophysiology of the globus pallidus, and the clinical practice of pallidotomy.


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