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Date sent: Tue, 23 May 2000 20:49:31 -0400 Send reply to: Parkinson's Information Exchange Network <[log in to unmask]> From: janet paterson <[log in to unmask]> Subject: PMID: 10753482: Behavioral complications of early pallidotomy To: [log in to unmask] > Behavioral complications of early pallidotomy > > A review of stereotactic medial pallidotomy of the 1950s in five > neurosurgical centers is presented. The surgical technique varied from > one center to the other. The results of surgery, however, seemed to be > quite equal, being positive in 70-90% of the patients. The surgical > mortality ranged from 0 to 13%. Behavioral complications were > adequately analyzed and reported from one center only and published by > three independent neurologists. The side effects included drowsiness > (12%), confusion (13.6%), mental deterioration (5%), memory deficit > (13.6%), and dysphasia (7.5-24%, the rate depending on the concomitant > brain atrophy). Among permanent side effects, 5% of the patients > presented with a mild postoperative mental deterioration, whereas > 13.6% had a severe memory deficit. In the four other centers, the > results and side effects were analyzed only by the surgeons and were > more biased. A comparison of the results and complications between > Leksell's early medial pallidotomy of 1951-1957 and recent medial > pallidotomies of the 1990s from two centers showed that 40 years ago > Leksell had at least as good results as, and less serious > complications than, two representative neurosurgeons of today. Even > when positive clinical results of GPi pallidotomy have recently been > reported from several centers, the patients seem to have improved > relatively little, the dyskinesias excepted, and the rate of side > effects has been quite high. The author is afraid that medial > pallidotomy will soon be abandoned as a method of choice in the > surgical treatment of Parkinson's disease, as in fact happened 40 > years ago. One should look for better surgical alternatives and > targets outside of the medial pallidum. Copyright 2000 Academic Press. > > LV Laitinen > Brain Cogn 2000 Apr;42(3):313-23 > Sophiahemmet Hospital, Stockholm, Sweden. > PMID: 10753482, UI: 20218804 > How does this relate to those (some on this List) who have promoted pallidotomy for most of the time that I have been here? The above article (thanks, Janet!) comes from Dr. Laitinen, the doctor who "brought back" pallidotomy (I did them in the early sixties when I was in training). Best, Bob ********************************************** Robert A. Fink, M. D., F.A.C.S., P. C. 2500 Milvia Street Suite 222 Berkeley, California 94704-2636 Telephone: 510-849-2555 FAX: 510-849-2557 WWW: http://www.dovecom.com/rafink/ mailto:[log in to unmask] "Ex Tristitia Virtus" *********************************************