Staged bilateral pallidotomy for treatment of Parkinson disease

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Object. Several investigators have described the motor benefits derived from performing unilateral stereotactic pallidotomy for the treatment of Parkinson disease (PD), but little is known about the efficacy and complication rates of bilateral procedures. The goal of this study was to assess both these factors in 12 patients.

Methods. Eleven patients with medically intractable PD underwent staged bilateral pallidotomy and one patient underwent a simultaneous bilateral procedure. Unilateral pallidotomy resulted in an improvement in the patients' Unified Parkinson Disease Rating Scale (UPDRS) total scores and motor subscores, Hoehn and Yahr stages, and Schwab and England Activities of Daily Living scores. There were no complications. The second procedures were performed 5 to 25 months after the first, and nearly complete 3-month follow-up data are available for eight of these patients. Staged bilateral pallidotomy did result in further improvements in some symptoms, but the patients proved to be less responsive to levodopa. In contrast to outcomes of the initial unilateral pallidotomy, there were significant complications. One patient suffered an acute stroke, two patients suffered delayed infarctions of the internal capsule, four patients had mild-to-moderate worsening of speech and increased drooling, and one patient complained of worsening memory.

Conclusions. Bilateral pallidotomy results in modest benefits but is associated with an increased risk of complications.

Article Information

Address reprint requests to: Jeff M. Bronstein, M.D., Ph.D., Department of Neurology, University of California at Los Angeles School of Medicine, Reed Neurological Research Center, 710 Westwood Plaza, Los Angeles, California 90024. email: jbronste@ucla.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Magnetic resonance images obtained after VPP in all patients. Axial images are shown on the left and coronal images are on the right for individual patients. The first operation is designated “a” and the second surgery is “b.” In most cases T2-weighted images are displayed, although gadolinium-enhanced T1-weighted images were used in some cases to provide a cleaner image of the lesions and surrounding anatomy.

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    Bar graph showing that bilateral pallidotomy reduced patients' responses to medication. Values represent differences between UPDRS total scores off and on medication. Score differences in individual patients (Cases 4, 5, 7, 10, and 12) are represented by solid black bars for the initial preoperative evaluation; striped bars for postoperative Evaluation 1; and solid white bars at postoperative Evaluation 3.

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