title: Unilateral and bilateral pallidotomy for idiopathic Parkinson's disease: a case series of 115 patients.
abstract: Lesioning of the internal pallidum is known to improve the symptoms of idiopathic Parkinson's disease (PD) and alleviate dyskinesia and motor fluctuations related to levodopa therapy. The benefit obtained contralateral to a single lesion is insufficient in some cases when symptoms are bilaterally disabling. However, reports of unacceptably high rates of adverse effects after bilateral pallidotomy have limited its use in such cases. We report on the outcome of unilateral (UPVP) and bilateral (BPVP) posteroventral pallidotomy in a consecutive case series of 115 patients with PD in the United Kingdom and Australia. After 3 months, UPVP resulted in a 27% reduction in the off medication Part III (motor) Unified Parkinson's Disease Rating Scale score and abolition of dyskinesia in 40% of cases. For BPVP, these figures were increased to 31% and 63%, respectively. Follow-up of a smaller group to 12 months found the motor scores to be worsening but benefit to dyskinesia and activities of daily living was maintained. Speech was adversely affected after BPVP, although the change was small in most cases. Unilateral and bilateral pallidotomy can be performed safely without microelectrode localisation. Bilateral pallidotomy appears to be more effective, particularly in reducing dyskinesia; in our experience, the side effects have not been as high as reported by other groups.
authors.affiliation: Department of Neurology, Radcliffe Infirmary, Oxford, United Kingdom.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Parkin
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Gregory
authors.forename: Richard
authors.initials: R
authors.lastname: Scott
authors.forename: Peter
authors.initials: P
authors.lastname: Bain
authors.forename: Peter
authors.initials: P
authors.lastname: Silburn
authors.forename: Bruce
authors.initials: B
authors.lastname: Hall
authors.forename: Richard
authors.initials: R
authors.lastname: Boyle
authors.forename: Carole
authors.initials: C
authors.lastname: Joint
authors.forename: Tipu Z
authors.initials: TZ
authors.lastname: Aziz
mesh_terms: D000368:Aged; D001264:Athetosis / Q000175:diagnosis / Q000503:physiopathology; D002819:Chorea / Q000175:diagnosis / Q000503:physiopathology; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D005917:Globus Pallidus / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D009460:Neurologic Examination; D010300:Parkinson Disease / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome