Peter,
 
Thanks for telling us of your experience with the pallidotomy.  The missing
bit of information is the name of the neurosurgeon.  Knowing this helps to
determine the method used in the pallidotomy.
 
Support post op:  Usually another doctor or parkinson specialist will be used
for the post operation problems.   Neurosurgeons do surgery.  But you should
have been assigned to a specialist for answers during post op.  They have
access to your files and should be skilled in the issues of post pallidotomy.
 Obviously, this is one question you forgot to ask.
 
Now for a few words on medications and the pallidotomy.
(1)  Medications should not be changed for at least three weeks post op.
 Then changes (increasing or decreasing) should be done in small amounts.  If
you were taking Artane or similar drugs, just stopping them can cause
withdrawal symptoms.  You will not know if symptoms are returning or the
surgery was unsuccessful.  You will not associate it with withdrawal.
 Remember, you just had brain surgery, don't shock the brain with med
changes.
(2)  Some patients are under medicated by choice.  Often they chose to be
under medicated because it is less painful than being over medicated.  It is
difficult for them to find the therapeutic region with pills.  These patients
will experience a new form of OFF after the pallidotomy.  The OFF time will
not be as bad as it used to be.  But if they would either (a) increase the
start up medication and/or (b) increase the amount of meds taken daily, they
would find the therapeutic region is wider.  Increasing meds will not put
them into dyskinesia.
(3) Some patients are over medicated by choice.  Often they chose to be over
medicated because it is less painful than being under medicated.  Often the
patient has a lot of dyskinesia.  When they do go into an OFF state freezing
and akinesia may happen.  This is very painful and seems to be a state not
wanted.  The net is additional medications will be taken to avoid the OFF
state.   After the pallidotomy, dyskinesia should not be present even at
current med levels.  Thus keeping the meds at the original level should be
acceptable.  Slowly after the third week, changes in meds can be started.
 Changes should be slow for reasons stated in (2).
 
Now it is assumed that in (2) above, meds would be increased and in (3) meds
would be decreased.  This is not always the case.  Some patients could have
become very responsive to Sinemet over time.  This means that over time they
have been taking less and less Sinemet and had stronger response (adverse).
 After the pallidotomy, the therapeutic region may have changed such that
additional medications are necessary after surgery for over medicated
patients pre-op.  Sounds strange, but it is true for some.
 
Finally, from my own experience, I found after pallidotomy (about 3 to 8
weeks post op) I was not ON like I remembered before surgery.  I was not in
the therapeutic window post op.  I found I needed to increase the startup
medications each day.  This raised me to the new location of the therapeutic
window.   Once I was there, the medications used during the day were
sufficient to hold me there.  You may need to experiment a little with the
startup medications until you find the amount necessary to put you in the new
therapeutic window.  This is not easy as the new therapeutic window is much
wider than the old window.  It is not as well defined as before surgery.
 This is a new game to play.  Enjoy it, you have not been like this for many
years.
 
As a post script, all pallidotomy patients will experience a memory problem.
 They forget almost immediately what they were like before surgery.  The new
yard stick, however, is the same as before surgery -- yesterday.  We compare
today with yesterday.  Don't ask me if I am better because of the pallidotomy
because that makes me compare today with a day some two years earlier.  I
can't do that.  I can tell you if today is better than yesterday or worse
than yesterday.  Don't expect much else.
 
Regards,
Alan