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Reply to Bob Fink Bob, Nancy is now 5 years post PVP and continues to benefit from the absence of dyskinesia. She is 55 years old and has had PD 25 years. Almost no circumstance or medication has been observed that rekindles the dyskinesia that was so disabling to her. (Unable to feed herself.) There was one exception. Tasmar triggered dyskinesia even when sinemet was reduced by 50%. So Tasmar was dropped even before the Tasmar negative publicity happened. As far as side effects go Nancy has NOT had slurred speech that can accompany bilateral PVP but her voice continues to soften. Sentence construction/completion is difficult now. Her thoughts seem to race ahead of her ability to express them. This is an intermittant problem. She has not recieved any benefit for her stooped posture. She has almost no tremor. She had minor tremor to begin with. Freezing still occurs but there has been improvement. Shorter duration and less intense. Persistance or compulsivness as a behavior seems to get worse each year. This could be just normal PD progression but my belief is that the PVP has contributed to this. Tough to prove and this comes from a caregiver who is also aging and obsessed with finding a cure. Double vision now hinders reading. I don't think this is related to PVP. Weight gain (20 lbs.) immediately following PVP not a problem now. Weight has returned to normal. Most of the subsequent weight loss occurred very quickly about 18 months ago. Would she do it again and would I recommend it to her again? I would have to say yes. She was becoming an invalid and she has been blessed with 5 more productive years. With DBS now available would we still do the PVP? I don't think so. We plan to discuss the DBS STN option with the Baylor team this fall. You might ask us again after that meeting. My continued belief is the best hope for people like Nancy is reengineered cell implantation. This is strictly intuitive but its where I am placing my bets and much of my advocacy effort. Regards. Bob Martone [log in to unmask] http://www.samlink.com/~bmartone not up and running yet -----Original Message----- 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. Subject: PMID: 10753482: Behavioral complications of early pallidotomy > 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 >