Usefulness of pallidotomy in advanced Parkinson's disease.
OBJECTIVE
The combined effect of posteroventral pallidotomy and optimal medical treatment was assessed in 22 patients with levodopa sensitive Parkinson's disease.


METHODS
Timed motor tests, video recordings, and computer assisted optoelectronic movement analysis were used for serial hourly assessments performed preoperatively and four and 12 months after operation. Tests were made while patients were on optimal medical therapy.


RESULTS
There were no serious adverse events of surgery. Two of the 22 patients could not complete all the tests after operation. The proportion of dyskinesia periods decreased in the 20 patients and there was a proportional increase in normal or fairly normal occasions. "Off" periods were not significantly affected. In 12 of 13 patients with limb dyskinesia this symptom was completely abolished in the contralateral limbs. There was also some degree of improvement axially and ipsilaterally. Tremor was moderately improved contralaterally. Bradykinesia remained unchanged. Results at 12 months follow up were similar to those at four months.


CONCLUSIONS
Pallidotomy produced a pronounced positive effect on dyskinesia and a moderate effect on tremor. Bradykinesia was not affected. Posteroventral pallidotomy may be useful in patients with Parkinson's disease who have severe motor fluctuations and may allow an increase in levodopa dose to alleviate bradykinesia in "off" states.
Johansson
F
F
Department of Neurology, University Hospital of Northern Sweden, Umeå, Sweden.
Malm
J
J
Nordh
E
E
Hariz
M
M
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D007980:Levodopa / Q000008:administration & dosage; D017770:Lifting; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D009069:Movement Disorders / Q000517:prevention & control; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D012086:Reoperation; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014202:Tremor / Q000517:prevention & control; D014741:Video Recording
D007980:Levodopa