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In a message dated 5/24/00 12:03:52 AM Eastern Daylight Time, [log in to unmask] writes: > > > 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 Bob, Although I find it impossible to keep up with the huge volume on the Parkinson's Digest occasionally I come across something which I feel compelled to respond. Dating back several years ago, we have had a basic disagreement as to the effectiveness of a pallidotomy and Dr. Iacono in particular. In response to your throwing down the gauntlet with your comment. All I can say is like the blind man Jesus healed in John 9. "One thing I know. I was blind but now I see." Seven years ago I had suffered the ravages of PD for 12 1/2 years. After numerous consultations with leading neurologists and neurosurgeons I came to the conclusion that Dr. Iacono was getting supeior results consistently with his pallidotomies. I entrusted myself to his care and I have been thankful ever since. Furthermore after four years helping out in his clinic weekly I can say without hesitation that his results far exceed those reported in studies such as you refer to. I say this knowing that Dr Iacono trained under Dr. Laitinen of Swedish fame. The difference being that Dr. Iacono used this training as a launching pad to develop his technique that enables him to precisely hit the target in the GPi within one mm whereas others are afraid to get any closer than three mm. Bob, based on our history years ago, I don't expect you to change your opinion but for the sake of others on the list I write this reply. From one whose life was restored 6 1/2 years ago, Don Don Berns B.S.M.E., clay pot, M.Div. Wounded Healer, P.D. D. Min. Parish Associate PHCPC Check out Don's pallidotomy story on website: New Corrected Web Address http://www.geocities.com/janet313/pienet/berns/index.html For more info on this life changing operation for persons with P.D. See: www.pallidotomy.com