Electromyography during stereotactic pallidotomy for Parkinson's disease

Howard Landy, William J. Weiner, Blair Calancie, William Harris, Lisa M. Shulman, Carlos Singer, Lisa Abrams, Brian Bowen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

In stereotactic pallidotomy for Parkinson's disease, care must be taken to avoid internal capsule injury while maximizing improvement of rigidity and tremor. In 21 patients, intraoperative electromyography (EMG) was used to assess stimulation thresholds required for capsular responses and to monitor muscle tone and tremor. Surface EMG electrodes were placed on the face and multiple muscle groups of the extremities. The stimulation and lesion electrode was introduced via MRI-guided stereotaxis toward a point 2-3 mm anterior to the midcommissural point, 5-6 mm inferior to the AC-PC plane, and 21-22 mm lateral to the midline. Exact targets were modified according to MRI-visualized anatomy. With stimulation at 5 and 50 Hz, thresholds for detection of EMG responses were usually seen at 4-5 mA. EMG responses were consistently seen prior to visual observation of muscle activity. Timing of EMG response relative to stimulus aided in differentiating stimulus-related movement from spontaneous tremor. Resting spontaneous EMG activity was seen to decrease as rigidity was improved by incremental lesion production. EMG activity related to tremor was recorded; tremor decrease by lesion production was documented by EMG recording. Patient cooperation with physiologic testing during stimulation and lesion production may become limited. Intraoperative EMG monitoring provides an adjunct to improve reliability of assessment of capsular stimulation and rigidity while providing documentation of lesion impact on rigidity and tremor.

Original languageEnglish
Pages (from-to)21-29
Number of pages9
JournalStereotactic and Functional Neurosurgery
Volume74
Issue number1
DOIs
StatePublished - Dec 1 2000

Fingerprint

Pallidotomy
Electromyography
Parkinson Disease
Tremor
Electrodes
Intraoperative Monitoring
Internal Capsule
Muscles
Patient Compliance
Documentation
Anatomy
Extremities
Observation

Keywords

  • Electromyography
  • Pallidotomy
  • Parkinson's disease

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Electromyography during stereotactic pallidotomy for Parkinson's disease. / Landy, Howard; Weiner, William J.; Calancie, Blair; Harris, William; Shulman, Lisa M.; Singer, Carlos; Abrams, Lisa; Bowen, Brian.

In: Stereotactic and Functional Neurosurgery, Vol. 74, No. 1, 01.12.2000, p. 21-29.

Research output: Contribution to journalArticle

Landy, H, Weiner, WJ, Calancie, B, Harris, W, Shulman, LM, Singer, C, Abrams, L & Bowen, B 2000, 'Electromyography during stereotactic pallidotomy for Parkinson's disease', Stereotactic and Functional Neurosurgery, vol. 74, no. 1, pp. 21-29. https://doi.org/10.1159/000056459
Landy, Howard ; Weiner, William J. ; Calancie, Blair ; Harris, William ; Shulman, Lisa M. ; Singer, Carlos ; Abrams, Lisa ; Bowen, Brian. / Electromyography during stereotactic pallidotomy for Parkinson's disease. In: Stereotactic and Functional Neurosurgery. 2000 ; Vol. 74, No. 1. pp. 21-29.
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