Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation

OBJECTIVE—Posteroventral pallidotomy (PVP) has proved to be an effective method for the treatment of Parkinson's disease. However, data on bilateral procedures are still limited. To assess the effects of bilateral globus pallidus (GPi) lesion and to compare it with a combination of unilateral GPi lesion plus contralateral GPi stimulation (PVP+PVS), an open blind randomised trial was designed.
METHODS—A prospective series of patients with severe Parkinson's disease refractory to medical treatment, and severe drug induced dyskinesias, were randomised either to simultaneous bilateral PVP or simultaneous PVP+PVS. All patients were assessed with the core assessment programme for intracerebral transplantation (CAPIT), and a comprehensive neuropsychological and neuropsychiatric battery both before surgery and 3 months later.
RESULTS—The severe adverse effects found in the first three patients subjected to bilateral PVP led to discontinuation of the protocol. All three patients developed depression and apathy. Speech, salivation, and swallowing, as well as freezing, walking, and falling, dramatically worsened. By contrast, all three patients undergoing PVP+PVS had a significant motor improvement.
CONCLUSION—Bilateral simultaneous lesions within the GPi may produce severe motor and psychiatric complications. On the other hand, a combination of PVP+ PVS significantly improves parkinsonian symptoms not associated with the side effects elicited by bilateral lesions.


Imagined races : from environmental determinism to geographical authenticity in twentieth‐century Argentina

This article explores how Argentine intellectuals incorporated the natural environment into their accounts of the racial, cultural and political features of the nation. In the late nineteenth century environmental determinism, based on the assumption of a cause–effect relationship between geographical and racial factors, entered Argentina through three main routes: Lamarckism, Darwinism and Spencerianism. By the mid twentieth century, however, anti‐positivist philosophies had been fully incorporated into a body of work that analysed Argentina's socio‐historical foundations. This article examines the shift that occurred during the first half of the twentieth century in how those seeking to define race incorporated the environment into their arguments. The raza was commonly taken to be synonymous with nation. Selected works by sociologist and legal scholar Carlos Octavio Bunge (1875‐1918) and by writer and ensayista Bernardo Canal Feijóo (1897‐1982) will be analysed as influential yet overlooked examples of how ‘the problem of Argentine culture’ could not be separated from the question of nature understood in terms of both physical and human geography. The goal will be to reveal, firstly, the extent to which the notion of the interior as geographical and anthropological desert deeply informed the political vision of the early national period in relation to race and nation and, secondly, how later interpretations of the nation recast American nature as a foundational element of cultural authenticity based on a sentiment of geographical belonging