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Dear Carol, Increasing the dose of levodopa (or entacapone in your case) is common after a pallidotomy or pallidal stimulation. This may cause a reappearance of tremors, which can only be treated by reducing the dose in the case of the pallidotomy or adjusting the stimulation in the case of pallidal stimulation. Your dose must have been increased due to other problems, probably gait disturbance and freezing. A patient with a pallidotomy does usually require frequent medication adjustments, but can be quite good with the correct dose regimen. However, sooner or later gait problems can not be treated anymore or side effects are so bad due to the increase of medication, that bilateral STN surgery is the only option. Greetings, Chris van der Linden, M.D.