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Christopher R. Honey, A. Jon Stoessl, Joseph K. C. Tsui, Michael Schulzer, and Donald B. Calne

P ain has long been recognized as a feature of Parkinson's disease (PD). 3, 22 Recent reviews have again focused attention on the alarmingly high prevalence of pain in patients with PD. 9, 11, 16, 20, 21 The percentage of patients suffering pain attributable to their PD has been estimated to be between 15% and 46%. 8, 11, 23 With the increased popularity of the pallidotomy procedure have come anecdotal comments on its ability to reduce pain. Laitinen and colleagues 12 reported that 63% of their patients had some degree of “dystonia/pain” before pallidotomy

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Kristian J. Bulluss, Erlick A. Pereira, Carole Joint, and Tipu Z. Aziz

I n the 1990s, publication of the long-term results of pallidotomy for advanced Parkinson's disease (PD) showing significant loss of dyskinesias, rigidity, and tremor led to a second resurgence of stereotactic surgery for PD. 11 However, the relatively high incidence of side effects in some series and the demonstration that bilateral subthalamic nucleus (STN) stimulation was effective and led to a significant reduction in drug requirement, unlike pallidal surgery, resulted in the procedure of choice becoming deep brain stimulation (DBS). With the

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Volker M. Tronnier, Wolfgang Fogel, Martin Kronenbuerger, and Sarah Steinvorth

P harmacological therapies are the current mainstay in the treatment of Parkinson's disease (PD). However, as the disease progresses the positive effects of the medication decrease and debilitating side effects may occur. The limitations of long-term pharmacological treatment have led to a renewed interest in surgical methods to relieve the major symptoms of PD: tremor, rigidity, and bradykinesia, as well as medication-induced side effects such as on—off fluctuations and levodopa-induced dyskinesias. In the 1940s and 1950s, pallidotomy was an established

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Emad N. Eskandar, G. Rees Cosgrove, Leslie A. Shinobu, and John B. Penney Jr.

M eyers 18 pioneered the surgical treatment of Parkinson's disease (PD) in the 1930s, initially with resection of the caudate nucleus and subsequently with lesioning in the ansa lenticularis. Chemopallidotomy was reported for the treatment of PD by Narabayashi and Okuma 19 in 1953, whereas Guiot and Brion 8 reported successful pallidotomy in which thermocoagulation was used in the same year. The initial surgical target was in the anterodorsal portion of the medial globus pallidus (GP), but Svennilson and colleagues 4, 23 noted better surgical outcomes with

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Ahmed Alkhani and Andres M. Lozano

P allidotomy has been used to treat patients with PD for the last 50 years. 25 However, the shift in the surgical target to the thalamus and, more important, the appearance of levodopa resulted in the near-total discontinuation of pallidotomy during the 1960s. The limitations and side effects of medications; advances in stereotactic neurosurgery, neuroimaging, and neurophysiological monitoring; and increased understanding of the pathophysiology of PD 21 have led to a reevaluation of surgery as a treatment for PD. In 1992 Laitinen and colleagues 50

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Alon Y. Mogilner, Djordje Sterio, Ali R. Rezai, Martin Zonenshayn, Patrick J. Kelly, and Aleksandar Beric

levodopa-induced dyskinesias. 17 Posteroventral pallidotomy, which was initially described by Svennilson, et al., 31 and reintroduced by Laitinen, et al., 16 in the early 1990s, remains an effective surgical procedure in alleviating many of the cardinal symptoms of PD, and is still performed as an alternative to DBS of the STN or pallidum. Although the reported beneficial effects of pallidotomy persist for some years in these patients, most develop a recurrence of symptoms on the side that underwent pallidotomy, as well as increasing symptomatology on the side that

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Peter M. Intemann, Donna Masterman, Indu Subramanian, Antonio DeSalles, Eric Behnke, Robert Frysinger, and Jeff M. Bronstein

the patient. 21, 25, 27, 33, 36 Despite these positive results, the disease continues to progress and symptoms ipsilateral to the surgical lesion can become disabling. The risks and benefits of performing a second surgery on the side opposite the initial unilateral VPP (staged bilateral pallidotomy) are not clear and studies have been largely anecdotal. The intention of the current study was to gain a better understanding of the efficacy and safety of staged bilateral VPP through a longitudinal analysis of clinical outcomes in patients with PD. Clinical

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Marwan I. Hariz and A. Tommy Bergenheim

I n January 1992 Laitinen, et al., 11 published a paper titled “Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease.” Many subsequent studies on PVP for PD have since been published from a large number of research centers worldwide. 1, 9, 12 Perhaps the most important and still unresolved issue concerns the long-term results of PVP. In our survey of the rich literature on pallidotomy for PD that has been published since 1992, we found only four studies in which the postoperative follow up extended beyond 2 years. In the first

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Shiro Horisawa, Mieko Oka, Kotaro Kohara, Takakazu Kawamata, and Takaomi Taira

vary depending on the etiological diseases. For patients with dystonic camptocormia refractory to the these treatments, deep brain stimulation (DBS) of the globus pallidus internus (GPi) is effective. 5 , 8 , 20 , 27 Ablation of the GPi (pallidotomy) has an effect on dystonia that is similar to that of GPi-DBS on dystonia without the need for implantation of any device. 6 However, there have been limited reports of the use of pallidotomy for dystonia. To the best of our knowledge, this is the first report of bilateral pallidotomy for tardive dystonic camptocormia

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Juei-Jueng Lin, Ging-Yau Lin, Chunhsi Shih, Shinn-Zong Lin, Dar-Cheng Chang, and Chan-Chian Lee

P harmacotherapeutic effects on patients with generalized dystonia are often disappointing. Although surgical therapy with thalamotomy can alleviate clinical symptoms in some patients, there are risks of complications and adverse effects, particularly when the surgery is bilateral. 1, 3 In recent years, there have been a few reports showing successful application of posteroventral pallidotomy (PVP) in the treatment of patients with dystonia. 6, 9 The results showed that surgical therapy could significantly ameliorate dystonic movements and improve motor