title: Short and long-term motor and cognitive outcome of staged bilateral pallidotomy: a retrospective analysis.
abstract: BACKGROUND
  We investigated retrospectively the short and long-term motor and cognitive functioning of staged bilateral pallidotomy using motor testing and a comprehensive neuropsychological battery before and after each procedure.
  
  
  METHODS
  Fifteen patients with idiopathic Parkinson's disease were assessed at baseline and at least 3 months after each of their two staged surgeries. Motor and neuropsychological results were compared to 15 non-surgical Parkinson's disease patients matched for disease stage and mental status. In addition, nine bilateral pallidotomy patients were evaluated for long-term cognitive changes (>2 years).
  
  
  RESULTS
  Bilateral pallidotomy patients demonstrated significant improvements in motor functioning in the "on" and "off" states and with dyskinesias after the first surgery, with an additional improvement reported for dyskinesias after the second procedure. On long-term follow-up, dyskinesia improvements were maintained. Bilateral pallidotomy patients did not show significant cognitive declines following both procedures on the short-term follow-up and when compared to the Parkinson's disease group. However, significant cognitive declines were found on the long-term follow-up evaluation.
  
  
  CONCLUSIONS
  Parkinson's disease patients received significant short- and long-term motor benefits, particularly reduced dyskinesias, following staged bilateral pallidotomy without significant short-term cognitive consequences. Two years following the second procedure, bilateral pallidotomy patients tended to show an increase in both motor and non-motor symptoms of Parkinson's disease, particularly cognitive decline.
authors.affiliation: Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA. myork@bcm.edu
authors.forename: M K
authors.initials: MK
authors.lastname: York
authors.forename: E C
authors.initials: EC
authors.lastname: Lai
authors.forename: J
authors.initials: J
authors.lastname: Jankovic
authors.forename: A
authors.initials: A
authors.lastname: Macias
authors.forename: F
authors.initials: F
authors.lastname: Atassi
authors.forename: H S
authors.initials: HS
authors.lastname: Levin
authors.forename: R G
authors.initials: RG
authors.lastname: Grossman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003071:Cognition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D009483:Neuropsychological Tests; D053860:Pallidotomy / Q000009:adverse effects; D010300:Parkinson Disease / Q000503:physiopathology* / Q000523:psychology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome