Lesions as therapy: Rigidity and Parkinson's Disease
Since James Parkinson first characterized the shaking palsy as a unique condition, significant confusion has remained concerning the causes and treatments of Parkinson's disease (PD). Through the 19th century, a wide variety of approaches were attempted in an effort to reduce its cardinal signs -- rigidity, tremor, and bradykinesia -- but to little effect. Today, approaching 200 years after Parkinson's seminal work, this disorder is commonly treated by surgical means, providing a lesion to one specific portion of the globus pallidus nucleus within the central nervous system.
The notion of providing a lesion to the nervous system as a therapy for PD, however, began in earnest at the beginning of the 20th century. The first attempt to alleviate the symptoms of PD through surgical means involved cutting the dorsal (sensory) roots of the spinal cord supplying the affected limb (also known as dorsal rhizotomy). Although ultimately resulting in disastrous effects, these early surgical attempts proceeded from a firm body of clinical and experimental research on both the central and peripheral nervous systems. After briefly reviewing the use and failure of dorsal rhizotomy as a treatment for Parkinsonian rigidity, this paper will examine the clinical and experimental foundations underlying this procedure.
Session VII -- Clinical Neurology and Neurosurgery
Providence, Rhode Island, USA