Dear fellow listservers,

The following was send by one of the listmembers to explain in lay-person's
terms the difference between the two surgical options; I thought to share
this with you all.

Regards,

Chris

> For those studying the two options, pallidotomy and
> bilateral STN, consider the
> following:
>
>
> 1.  Pallidotomy is a relatively old procedure first used
> about 50 years ago.  The advent of Sinemet and other
> drugs that were effective on PD made pallidotomy
> unecessary.  When the drugs began to fail -- the known
> effective surgical treatment was pallidotomy.  Therefore
> that is what was used.
>
> 2.  Like everything about PD, no two people are alike.
> Many pallidotomies gradually become ineffective after 4
> to 5 years --- but there are patients who have excellent
> effects for a longer period.  Same as with medications.
> Many of the pallidotomies were done before the newer
> technology was even developed or was in the research
> stages.
>
> 3.  In layman's terms ---- a pallidotomy is kind of like
> fixing a defective transmission in a car by welding the
> gears into a position that works the best under most
> driving conditions.  If the engine becomes weaker or you
> come to a big hill (ie. your PD deteriorates) you can
> not undo the "repair" --- it is permanent.  You can no
> longer change gears in that part of the drive train.
>
> 4.  Bilateral STN --- is like buying a computer and
> printer cable.   The subthalamic nucleus is the
> "printer"  The "printer cable" is connected to the
> subthalamic nucleus and the internal pulse generator
> (IPG), the computer, is connected to the cable.  The IPG
> sends the signal to the STN telling it what to "print"
> or what "not to print".  If you do not like the message
> sent to the printer (your STN) you change it.  You send
> it a new "email".
>     If the computer fails -- you connect a new one to
> the cable (a simple outpatient procedure).
>     If a newer computer and program comes along you can
> plug a new computer to the cable and use the newer
> technology.
>     AND --- if in the future a completely new technology
> develops that does not require this computer or printer
> cable you can remove them and install the new equipment
> OR use the new medical treatment because you have not
> damaged the printer (the STN).
>
> 5.  With either procedure there is a risk of
> complications as there is with any surgical procedure to
> the brain.  The historical results show that the risk,
> though real, is very very low.
>
> I hope this explanation puts the choice in
> understandable, layman's terms.
>
>