Copper and zinc levels in familial amyotrophic lateral sclerosis patients with cuznsod gene mutations

✍ Scribed by A. Radunović; H. T. Delves; W. Robberecht; P. Tilkin; Z. E. Enayat; C. E. Shaw; Z. Stević; S. Apostolski; J. F. Powell; P. N. Leigh

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 227 KB
• Volume: 42
• Category: Article
• ISSN: 0364-5134
• DOI: 10.1002/ana.410420124

✦ Synopsis

to worsening of parkinsonian symptoms. Because Verhagen and co-workers [3] do not provide confirmation of their lesion locations, it is conceivable that their lesions encroached on the GPe.

The second point raised by Krack and colleagues, is not really relevant, since it seems to apply solely to DBS and not to pallidotomy. The mechanism underlying the effect of DBS on akinesia is unclear. The worsening of akinesia from ventral pallidal stimulation could be secondary to increased pallidal (inhibitory) output.

The authors' third point, that DBS permits optimization of stimulation and location parameters is true, but it does not necessarily follow that DBS is therefore superior to pallidotomy. Of concern is the apparent limited benefit of DBS for tremor and drug-induced dyskinesias. Moreover, the results of bilateral DBS (5 of 8 were bilateral procedures) cannot be compared directly with those of unilateral pallidotomy. The benefits of pallidotomy versus DBS can only be addressed in a randomized controlled clinical trial that compares unilateral and bilateral procedures in comparable populations.