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- W2026171569 abstract "Whenoneexamines stained sections ofthethalamic areaofthebrain andsees themassoffibres andcells inthis areainterconnecting almost every structure in thevicinity andreceiving andsending millions of fibres toremote parts ofthebrain andspinal cord onemarvels atthetemerity oftheearly stereotactic surgeons whodared toplace electrodes inthis area andmakemassive destructive lesions. Onemight imagine thatsuchlesions wouldhaveaprofound effect ongait andmotorcontrol, onsensation and evenmental function but,inpractice, theclinical effects ofsuchmassive lesions arehardly detectable. Whether this reflects thehighdegree ofadaptability inthebrain ortherelative unimportance ofthis area isdifficult todetermine. Themaindifficulty encountered bythesurgeon probing this areaisto produce anyeffect atall. Allvarieties oftest procedures areusedtodetermine theefficacy oflesions -stimulation, micro-electrode recording, 'trial lesions' withheat orcold-and yet, insomeinstances, noclinical effect canbeproduced. Mostofsuchlesions aremadeforthetreatment ofinvoluntary movements, particularly thetremor andrigidity ofParkinsonism. Theresults ingeneral areexcellent, yetthese abnormal movements are presumed tobetheresult ofcell andfibre destruction anditisamatter forgreat surprise that suchlesions donotinthemselves invoke involuntary movements. Thatwefindsuchconcepts difficult tounderstand maywellreflect wrongthinking onourpartconcerning theorganization ofthenervous system. When weseeadiscrete tract offibres, oracollection ofcells ofsimilar size andconnexions, wetendtothink that they mustserve somesingle function. Wemayaccept theideathat this function differs fromtimetotime andmaywell depend onthestate ofother parts ofthe nervous system atthattime. Ourminds, however, arenotsufficiently alive tothepossibility thatsucha discrete system maywell beserving several functions, often directly opposed toeachother. Fibres which facilitate orinhibit certain function maywellrun sidebysideandthephysical destruction ofboth could wellhavenoapparent clinical effect atall. Involuntary movements aremostoften theresult ofinfections, ofdegenerations ofunknowncause, orofdevelopmental anomalies. Itiseasytoconceive thatsuchprocesses mayaffect onlyfacilitatory or inhibitory fibres, butnotboth, andthatthegross physical lesions madebythesurgeon destroy both andcancel outtheimbalance. Tremorandrigidity, ballismus andathetosis, areveryrarely caused by discrete physical lesions suchastumourgrowth, thoughoccasional casesarereported andthis suggestion maywellaccount forthefactthatthe surgeon destroying large areas oftheglobus pallidus, lateral thalamus, andadjacent structures relatively seldominduces involuntary movements ormakes themworse. Suchcomplications do,however, occur, inasmall proportion ofcases, about2-5%overall, andthe situation ofsuchlesions, together withthepreexisting state ofthenervous system, seemed aworthwhile study andformsthebasis ofthis paper." @default.
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- W2026171569 date "1965-08-01" @default.
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- W2026171569 title "Involuntary movements following stereotactic operations for Parkinsonism with special reference to hemi-chorea (ballismus)" @default.
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- W2026171569 doi "https://doi.org/10.1136/jnnp.28.4.291" @default.
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