Bilateral posteroventral pallidotomy in advanced Parkinson's disease in three patients.
In this report, we describe the effect of staged bilateral posteroventral pallidotomy in three patients with advanced Parkinson's disease who were all of the young-onset type. Two patients had developed response fluctuations after the use of levodopa, with severe hypokinesia, painful dystonia, and rigidity in the "off" phase and violent dyskinesias in the "on" phase. One patient, in a continuous hypokinetic rigid state, was totally unresponsive to dopaminergic medication. All were at Hoehn and Yahr stage 5 in the "off" phase before surgery. After surgery, the hypokinetic state was reversed and dyskinesias were abolished in all patients. Hoehn and Yahr stages were 3 in the "off" phase postoperatively. Overall functional improvement was marked and lasting after follow-up for 7, 12, and 13 months, respectively. Complications were visual field deficit and transient central facial paresis, both in the same patient. Bilateral posteroventral pallidotomy can ameliorate response fluctuations, hypokinesia, rigidity, and painful dystonia in advanced Parkinson's disease.
Schuurman
P R
PR
Graduate School of Neurosciences, Department of Neurology, University of Amsterdam, The Netherlands.
de Bie
R M
RM
Speelman
J D
JD
Bosch
D A
DA
D000203:Activities of Daily Living; D017668:Age of Onset; D000978:Antiparkinson Agents / Q000627:therapeutic use; D004351:Drug Resistance; D004409:Dyskinesia, Drug-Induced / Q000601:surgery; D004421:Dystonia / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D018476:Hypokinesia / Q000601:surgery; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009127:Muscle Rigidity / Q000601:surgery; D010300:Parkinson Disease / Q000188:drug therapy / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa