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10 - Paradoxes in Parkinson's disease and other movement disorders

Published online by Cambridge University Press:  05 December 2011

Ashwani Jha
Affiliation:
Institute of Neurology
Peter Brown
Affiliation:
Institute of Neurology
Narinder Kapur
Affiliation:
University College London
Alvaro Pascual-Leone
Affiliation:
Harvard Medical School
Vilayanur Ramachandran
Affiliation:
University of California, San Diego
Jonathan Cole
Affiliation:
University of Bournemouth
Sergio Della Sala
Affiliation:
University of Edinburgh
Tom Manly
Affiliation:
MRC Cognition and Brain Sciences Unit
Andrew Mayes
Affiliation:
University of Manchester
Oliver Sacks
Affiliation:
Columbia University Medical Center
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Summary

Summary

The phenomenon of paradoxical facilitation has its greatest clinical impact in the field of movement disorders. Tens of thousands of people suffering from Parkinson's disease have spectacularly improved thanks to precisely placed surgical lesions or electrical stimulation deep in the centre of the brain. This chapter reports how this paradoxical benefit has driven science and medicine to unravel some of the secrets of one of the most complex circuits in the brain – the basal ganglia. We describe how careful anatomical studies of the basal ganglia have exposed their underlying circuitry, allowing scientists to ascribe function and capture dysfunction in disease. Against this background, we set a number of clinical paradoxes that challenge this model. These force us to take a leap in our conceptualization of the brain, considering it as a plastic network, perturbed by one or more disruptive signals in disease.

Meyers' observation – the paradox

As a young neurosurgeon in the Brooklyn Hospital, New York, Russell Meyers was inspired by an anecdote from his supervisor E. Jefferson Browder. Whilst performing a frontal lobectomy (presumably to remove a tumour), Browder had to extend the lesion far back into an unaffected area deep in the centre of the brain known as the basal ganglia. Coincidentally this patient also had early signs similar to Parkinson's disease, a degenerative condition causing slow, stiff movement and shaking. When the patient awoke after surgery, Browder noted something very unexpected. The patient's Parkinsonian symptoms had disappeared, completely (Meyers,1940; Clower, 2002).

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Chapter
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The Paradoxical Brain , pp. 189 - 203
Publisher: Cambridge University Press
Print publication year: 2011

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