Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine

Autores
Merello, Marcelo Jorge; Perez Lloret, Santiago; Antico, J.; Obeso, J. A.
Año de publicación
2006
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background: Dyskinesias are a transient but severe complication of subthalamotomy in some patients. Patients and methods: Three patients with Parkinson’s disease undergoing bilateral micro-recording guided surgery of the subthalamic nucleus (STN) are described; deep brain stimulation (DBS) was used in one case, and subthalamotomy in the other two. Prior to surgery, levodopa induced dyskinesia had improved (⩽50%) under treatment with amantadine (400 mg/day, po) in all three patients. The patient treated with DBS developed severe dyskinesia a few days after discharge and began self medication with amantadine but showed no improvement. This suggested a possible lack of response to amantadine for treatment of dyskinesias induced by surgery of the STN. Results: Both patients treated with bilateral subthalamotomy developed unilateral choreoballistic movements immediately after surgery, despite not taking levodopa (L-dopa). Patients were scored using the dyskinesia scale and started treatment with 400 mg amantadine (po) for 4 days within the first postoperative week with no effect on dyskinesia score or its phenomenology. Amantadine was therefore discontinued. One month after surgery both patients were free of involuntary movements with an improvement of about 60% in the “off” state UPDRS motor score. Six month follow up showed maintained antiparkinsonian benefit, without need for levodopa treatment and complete absence of dyskinesia. Conclusion: The present findings suggest that: (i) amantadine probably exerts its anti-dyskinetic effect by acting on the “indirect” pathway; (ii) the pathophysiological mechanisms of subthalamotomy induced dyskinesias may differ from those involved in L-dopa induced dyskinesias; (iii) dyskinesias induced by STN surgery resolve spontaneously as compensatory mechanisms develop.
Fil: Merello, Marcelo Jorge. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Perez Lloret, Santiago. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Antico, J.. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina
Fil: Obeso, J. A.. Universidad de Navarra; España
Materia
PARKINSON
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/242490

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spelling Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadineMerello, Marcelo JorgePerez Lloret, SantiagoAntico, J.Obeso, J. A.PARKINSONhttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3Background: Dyskinesias are a transient but severe complication of subthalamotomy in some patients. Patients and methods: Three patients with Parkinson’s disease undergoing bilateral micro-recording guided surgery of the subthalamic nucleus (STN) are described; deep brain stimulation (DBS) was used in one case, and subthalamotomy in the other two. Prior to surgery, levodopa induced dyskinesia had improved (⩽50%) under treatment with amantadine (400 mg/day, po) in all three patients. The patient treated with DBS developed severe dyskinesia a few days after discharge and began self medication with amantadine but showed no improvement. This suggested a possible lack of response to amantadine for treatment of dyskinesias induced by surgery of the STN. Results: Both patients treated with bilateral subthalamotomy developed unilateral choreoballistic movements immediately after surgery, despite not taking levodopa (L-dopa). Patients were scored using the dyskinesia scale and started treatment with 400 mg amantadine (po) for 4 days within the first postoperative week with no effect on dyskinesia score or its phenomenology. Amantadine was therefore discontinued. One month after surgery both patients were free of involuntary movements with an improvement of about 60% in the “off” state UPDRS motor score. Six month follow up showed maintained antiparkinsonian benefit, without need for levodopa treatment and complete absence of dyskinesia. Conclusion: The present findings suggest that: (i) amantadine probably exerts its anti-dyskinetic effect by acting on the “indirect” pathway; (ii) the pathophysiological mechanisms of subthalamotomy induced dyskinesias may differ from those involved in L-dopa induced dyskinesias; (iii) dyskinesias induced by STN surgery resolve spontaneously as compensatory mechanisms develop.Fil: Merello, Marcelo Jorge. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Perez Lloret, Santiago. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Antico, J.. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Obeso, J. A.. Universidad de Navarra; EspañaB M J Publishing Group2006-12info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/242490Merello, Marcelo Jorge; Perez Lloret, Santiago; Antico, J. ; Obeso, J. A.; Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine; B M J Publishing Group; Neuropsychiatry Of Basal Ganglia; 77; 2; 12-2006; 172-1740022-3050CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077561/info:eu-repo/semantics/altIdentifier/url/https://jnnp.bmj.com/content/77/2/172.longinfo:eu-repo/semantics/altIdentifier/doi/10.1136/jnnp.2005.068940info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-29T10:09:49Zoai:ri.conicet.gov.ar:11336/242490instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-29 10:09:49.887CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine
title Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine
spellingShingle Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine
Merello, Marcelo Jorge
PARKINSON
title_short Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine
title_full Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine
title_fullStr Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine
title_full_unstemmed Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine
title_sort Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine
dc.creator.none.fl_str_mv Merello, Marcelo Jorge
Perez Lloret, Santiago
Antico, J.
Obeso, J. A.
author Merello, Marcelo Jorge
author_facet Merello, Marcelo Jorge
Perez Lloret, Santiago
Antico, J.
Obeso, J. A.
author_role author
author2 Perez Lloret, Santiago
Antico, J.
Obeso, J. A.
author2_role author
author
author
dc.subject.none.fl_str_mv PARKINSON
topic PARKINSON
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Background: Dyskinesias are a transient but severe complication of subthalamotomy in some patients. Patients and methods: Three patients with Parkinson’s disease undergoing bilateral micro-recording guided surgery of the subthalamic nucleus (STN) are described; deep brain stimulation (DBS) was used in one case, and subthalamotomy in the other two. Prior to surgery, levodopa induced dyskinesia had improved (⩽50%) under treatment with amantadine (400 mg/day, po) in all three patients. The patient treated with DBS developed severe dyskinesia a few days after discharge and began self medication with amantadine but showed no improvement. This suggested a possible lack of response to amantadine for treatment of dyskinesias induced by surgery of the STN. Results: Both patients treated with bilateral subthalamotomy developed unilateral choreoballistic movements immediately after surgery, despite not taking levodopa (L-dopa). Patients were scored using the dyskinesia scale and started treatment with 400 mg amantadine (po) for 4 days within the first postoperative week with no effect on dyskinesia score or its phenomenology. Amantadine was therefore discontinued. One month after surgery both patients were free of involuntary movements with an improvement of about 60% in the “off” state UPDRS motor score. Six month follow up showed maintained antiparkinsonian benefit, without need for levodopa treatment and complete absence of dyskinesia. Conclusion: The present findings suggest that: (i) amantadine probably exerts its anti-dyskinetic effect by acting on the “indirect” pathway; (ii) the pathophysiological mechanisms of subthalamotomy induced dyskinesias may differ from those involved in L-dopa induced dyskinesias; (iii) dyskinesias induced by STN surgery resolve spontaneously as compensatory mechanisms develop.
Fil: Merello, Marcelo Jorge. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Perez Lloret, Santiago. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Antico, J.. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina
Fil: Obeso, J. A.. Universidad de Navarra; España
description Background: Dyskinesias are a transient but severe complication of subthalamotomy in some patients. Patients and methods: Three patients with Parkinson’s disease undergoing bilateral micro-recording guided surgery of the subthalamic nucleus (STN) are described; deep brain stimulation (DBS) was used in one case, and subthalamotomy in the other two. Prior to surgery, levodopa induced dyskinesia had improved (⩽50%) under treatment with amantadine (400 mg/day, po) in all three patients. The patient treated with DBS developed severe dyskinesia a few days after discharge and began self medication with amantadine but showed no improvement. This suggested a possible lack of response to amantadine for treatment of dyskinesias induced by surgery of the STN. Results: Both patients treated with bilateral subthalamotomy developed unilateral choreoballistic movements immediately after surgery, despite not taking levodopa (L-dopa). Patients were scored using the dyskinesia scale and started treatment with 400 mg amantadine (po) for 4 days within the first postoperative week with no effect on dyskinesia score or its phenomenology. Amantadine was therefore discontinued. One month after surgery both patients were free of involuntary movements with an improvement of about 60% in the “off” state UPDRS motor score. Six month follow up showed maintained antiparkinsonian benefit, without need for levodopa treatment and complete absence of dyskinesia. Conclusion: The present findings suggest that: (i) amantadine probably exerts its anti-dyskinetic effect by acting on the “indirect” pathway; (ii) the pathophysiological mechanisms of subthalamotomy induced dyskinesias may differ from those involved in L-dopa induced dyskinesias; (iii) dyskinesias induced by STN surgery resolve spontaneously as compensatory mechanisms develop.
publishDate 2006
dc.date.none.fl_str_mv 2006-12
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/242490
Merello, Marcelo Jorge; Perez Lloret, Santiago; Antico, J. ; Obeso, J. A.; Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine; B M J Publishing Group; Neuropsychiatry Of Basal Ganglia; 77; 2; 12-2006; 172-174
0022-3050
CONICET Digital
CONICET
url http://hdl.handle.net/11336/242490
identifier_str_mv Merello, Marcelo Jorge; Perez Lloret, Santiago; Antico, J. ; Obeso, J. A.; Dyskinesias induced by subthalamotomy in Parkinson's disease are unresponsive to amantadine; B M J Publishing Group; Neuropsychiatry Of Basal Ganglia; 77; 2; 12-2006; 172-174
0022-3050
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077561/
info:eu-repo/semantics/altIdentifier/url/https://jnnp.bmj.com/content/77/2/172.long
info:eu-repo/semantics/altIdentifier/doi/10.1136/jnnp.2005.068940
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
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rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
application/pdf
dc.publisher.none.fl_str_mv B M J Publishing Group
publisher.none.fl_str_mv B M J Publishing Group
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repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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