Pallidotomy for Parkinson’s
Source: Kishore A, et al. Efficacy, stability, and predictors of outcome of pallidotomy for Parkinson’s disease. Six-month follow-up with additional 1-year observations. Brain 1997; 120:729-737.
Kishore et al studied 24 patients, of whom 13 were men with a total mean age of 61 ± 11.3 years. Duration of disease averaged 14 ± 7 years with fluctuations and dyskinesias, respectively, present for 7.1 ± 4 and 6.5 ± 4 years. Pallidotomy was carried out by CT stereotaxis. Complications included: one death from an acute cerebral hemorrhage in the track of the electrode; two temporary hemipareses; three scotomas; and a facial palsy. Of the total cohort, 20 patients could be evaluated at six months and 11 at 12 months. The authors indicate that older patients improved more than younger ones at follow-up. Levodopa dyskinesias lessened on both sides. Other improvement was confined to functions contralateral to the pallidotomy. Treatment failures, if any, are not reported. Percent significant improvement relative to baseline is shown in the table.
Table
Improvement relative to baseline with pallidotomy
Off On
Rest Tremor 79% NS*
Rigidity 55% 38%
Bradykinesia 43% NS*
Peg Board Skill 49% 20%
COMMENTARY
The authors compare their results favorably with other more complicated approaches to pallidotomy using MRI or electrodes for stereotaxic localization of the globus pallidus. They comment that no complications have occurred in 30 additional patients following the completion of the present study. Only increased time and functional comparisons with lengthier outcomes will tell whether this simpler approach to pallidotomy in PD will continue to meet the standards set by more elaborate approaches of MRI and electrode guidance. Furthermore, as high-frequency stimulation of the globus pallidus becomes more intensively tested, it may equal or exceed pallidotomy in producing long-term outcome and safety. Time will tell. fp
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