Neurosurgical Management of Unusual Movement Disorders

摘要

Contemporary stereotactic surgery is primarily implemented for 3 distinct movement disorders. These include Parkinson disease, familial or essential tremor, and the dystonias. Specific structures within the central portion of the brain are thought to be functioning improperly and if these structures can be influenced, either by ablation or chronic stimulation, then the symptoms of the previously mentioned movement disorders can be modified. The targets for these conditions are better defined than other potential targets for other types of movement disorders. These targets include the subthalamic nucleus (stn) for the treatment of Parkinson disease. The ventral intermediate nucleus (vim) is the primary target for familial or essential tremor. Most recently, the globus pallidus internus (gpi) has been shown to be a promising target for treating dystonia. Investigators studying outcomes from stereotactic procedures have extrapolated results from these studies and applied them in an attempt to treat other, more unusual movement disorders, These disorders include tremor from multiple sclerosis, dystonic movements from cerebral palsy, and movement disorders produced as a result of stroke or head injury, Despite the uncertainty of which target in the brain from which such movements are derived, these conditions may respond to stereotactic intervention directed toward stn, vim, or gpi. Movement disorders such as torticollis, chorea, and spasticity can also respond to functional neurosurgical intervention. Other conditions that may respond to stereotactic procedures, and may have abnormal movements associated with them, include epilepsy and certain psychiatric conditions such as obsessive-compulsive disorder, but are not the focus of this article.