On Thu, 30 Jul 1998, Joanna Porvin wrote:

> Hello all.
>
> I read this article with interest and no small amount of concern.  I have two
> questions to throw out to the group:
>
> 1.  I am unfamiliar with the term "posteroventral stereotactic."  Could one of
> our medical folks please elaborate?  Is this just the formal name for the most
> common type of pallidotomy?

yes it is formal name for my pallidotomy --on left side
> 2.  I would be interested to hear from PWPs and CGs who have had *first-hand*
> experience with pallidotomy, specifically could you please address the
> "cognitive impairment and behavioral changes" you experienced/witnessed.
I was not tested before so loss of word skills cannot be confirmed
 I know there is some loss.
Dr said there are a few others with same changes

pallidotomy is not a permanent fix

Anne Rutherford 64 dx1980

> In a message dated 7/29/98 11:11:32 PM EST,
[log in to unmask] writes:
>
> > Surgery for Parkinson's disease carries
> >  neuropsychologic risks
> >
> >  WESTPORT, Jul 29 (Reuters) - Unilateral posteroventral
> >  pallidotomy for the treatment of Parkinson's disease is
> >  sometimes associated with modest cognitive impairment and
> >  behavioral changes, Canadian researchers warn in the July
> >  issue of Neurology.
> >
> >  Dr. Lisa L. Trepanier, of The Toronto Hospital-Western
> >  Division, in Ontario, Canada, with colleagues there and
> >  elsewhere, studied 42 patients with advanced Parkinson's
> >  disease who had "...substantial disability because of frequent
> >  'off' periods or drug-induced dyskinesias."
> >
> >  Twenty-four patients underwent posteroventral stereotactic
> >  pallidotomy on the right hemisphere of the brain and 18
> >  patients on the left side of the brain. Before surgery and 3, 6
> >  and/or 12 months afterward, each patient completed a battery
> >  of neuropsychologic tests.
> >
> >  As a group, the patients showed improvements in attention
> >  and concentration by 6 months after surgery compared with
> >  their preoperative test scores, Dr. Trepanier's team reports.
> >  Their working-memory capacity declined, however.
> >  Conditional associative learning, a measure of frontal
> >  executive function, was not affected.
> >
> >  Among patients who had undergone left-sided pallidotomies,
> >  the team found that verbal learning was impaired in 60% at the
> >  time of the first follow-up examination, 3 or 6 months after
> >  surgery. Verbal fluency had also declined significantly. Most
> >  patients with impaired verbal learning showed no improvement
> >  during the study period, and none regained their initial ability.
> >
> >  In contrast, verbal learning significantly improved in 44% of
> >  right-pallidotomy patients, the investigators determined.
> >  Right-hemisphere pallidotomies impaired visuospatial
> >  constructional ability, but all except one patient recovered this
> >  ability completely within 12 months after surgery.
> >
> >  In 25% to 30% of the patients, pallidotomy "...resulted in
> >  poorer frontal executive behavioral control (eg, environmental
> >  dependency, lack of insight, lability, depression, poor
> >  judgment, impulsiveness, obsessive-compulsive behavior),"
> >  the Toronto researchers report.
> >
> >  "For some patients, these problems negatively affected their
> >  relationship with caregivers, especially when they lacked
> >  awareness of their deficits or when altered judgment and
> >  increased emotional lability were present," the authors note.
> >  "These difficulties also restricted proper functioning at work or
> >  in social settings, depending on the patients' circumstances."
> >
> >  Dr. Trepanier's group recommends that "...the neurologic
> >  benefits of unilateral pallidotomy...be weighed against modest
> >  cognitive and behavioral risks."
> >
> >  Neurology 1998;51:207-215.
> >  --
> >  Judith Richards, London, Ontario, Canada
> >  [log in to unmask]
> >
>