Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD--a comparison of neuropsychological effects.
OBJECTIVE
To compare the cognitive and behavioural effects of unilateral pallidotomy and bilateral subthalamic nucleus (STN) stimulation.


METHODS
After baseline examination 34 patients were randomly assigned to unilateral pallidotomy (4 left-sided, 10 right-sided) or bilateral STN stimulation (n = 20). At baseline and six and twelve months after surgery we administered neuropsychological tests of language, memory, visuospatial function, mental speed and executive functions. Also a depression rating scale, and self and proxy ratings of memory and dysexecutive symptoms were administered.


RESULTS
Six months after surgery, the STN group and the pallidotomy group differed significantly in change from baseline in number of errors on two tests of executive functioning. After 12 months the STN group reported less positive affect compared with baseline than the pallidotomy group. One patient in the STN group showed an overall cognitive deterioration due to complications.


CONCLUSIONS
Although we need larger groups to draw firm conclusions, our results suggest that bilateral STN stimulation has slightly more negative effects on executive functioning than unilateral pallidotomy.
Smeding
Harriet M M
HM
Dept. of Neurology, H2-222, Academic Medical Center, 22660, 1100, DD Amsterdam, The Netherlands. h.m.smeding@amc.uva.nl
Esselink
Rianne A J
RA
Schmand
Ben
B
Koning-Haanstra
Marthe
M
Nijhuis
Ilse
I
Wijnalda
Elze M
EM
Speelman
Johannes D
JD
D046690:Deep Brain Stimulation; D003710:Demography; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D010300:Parkinson Disease / Q000503:physiopathology* / Q000601:surgery*; D011612:Psychosurgery / Q000379:methods*; D018709:Statistics, Nonparametric; D020531:Subthalamic Nucleus / Q000528:radiation effects*; D013997:Time Factors; D016896:Treatment Outcome
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