Anatomic verification of the lesion which abolishes parkinsonian tremor and rigidity

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Abstract
The anatomic lesion capable of producing total abolition of parkinsonian tremor and rigidity, without production of sensory, motor, intellectual, or psychologic deficit, is centered in the ventrolateral nucleus of the thalamus and involves to a lesser extent the posteroventrolateral and pos-teroventromedial nuclei. In some instances, the zona incerta, H fields of Forel, reticular nucleus of the thalamus, and the immediately adjacent portion of the internal capsule may be involved. This lesion is in a position to interrupt pallidothalamic radiations, corticothalamic circuits, and intrathalamic connections. One of the most striking features of the lesions in these cases was the interruption of the major portion of the dentatorubrothalamic pathway. Invasion of the subthalamic nucleus in one of these cases did not produce any evidence of hemi-ballismus or hemichorea. In 1 case, a lesion of the ventrolateral nucleus of the thalamus which did not invade the subthalamic nucleus, resulted in a hemiballistic syndrome, even though tremor and rigidity were abolished in the contralateral extremities. This postoperative hyperkinesis was eventually alleviated by the infliction of a medical globus pallidus lesion.

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