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?

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.

Thanks from all of us.
Joanna (CG)

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]
>