Randomized trial of pallidotomy versus medical therapy for Parkinson's disease.
Thirty-six patients with Parkinson's disease (PD) were randomized to either medical therapy (N = 18) or unilateral GPi pallidotomy (N = 18). The primary outcome variable was the change in total Unified Parkinson's Disease Rating Scale (UPDRS) score at 6 months. Secondary outcome variables included subscores and individual parkinsonian symptoms as determined from the UPDRS. At the six month follow-up, patients receiving pallidotomy had a statistically significant reduction (32% decrease) in the total UPDRS score compared to those randomized to medical therapy (5% increase). Following surgery, patients' showed improvement in all the cardinal motor signs of PD including tremor, rigidity, bradykinesia, gait and balance. Drug-induced dyskinesias were also markedly improved. Although the greatest improvement occurred on the side contralateral to the lesion, significant ipsilateral improvement was also observed for bradykinesia, rigidity and drug-induced dyskinesias. A total of twenty patients have been followed for 2 years to assess the effect of time on clinical outcome. These patients have shown sustained improvement in the total UPDRS (p < 0.0001), "off" motor (p < 0.0001) and complications of therapy subscores (p < 0.0001). Sustained improvement was also seen for tremor, rigidity, bradykinesia, percent on time and drug-induced dyskinesias.
Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA. jvitek@emory.edu
Jerrold L
JL
Vitek
Roy A E
RA
Bakay
Alan
A
Freeman
Marian
M
Evatt
Joanne
J
Green
William
W
McDonald
Michael
M
Haber
Huiman
H
Barnhart
Natalie
N
Wahlay
Shirley
S
Triche
Klaus
K
Mewes
Vijay
V
Chockkan
Jian-Yu
JY
Zhang
Mahlon R
MR
DeLong
D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology; D002230:Carbidopa / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004338:Drug Combinations; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D018476:Hypokinesia / Q000175:diagnosis / Q000453:epidemiology; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009127:Muscle Rigidity / Q000175:diagnosis / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000379:methods*; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014202:Tremor / Q000601:surgery
D000978:Antiparkinson Agents; D004338:Drug Combinations; C009265:carbidopa, levodopa drug combination; D007980:Levodopa; D002230:Carbidopa