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ANA: Deep Brain Stimulation Beneficial for Parkinson's Patients With Prior Pallidotomy By Paula Moyer SAN FRANCISCO, CA -- November 10, 2003 -- Patients with Parkinson's disease benefit from subthalamic nucleus deep brain stimulation (STN DBS) even if they have had a prior pallidotomy. These findings were presented here November 4th at the 128th Annual Meeting of the American Neurological Association. "This surgery is now a standard therapy for the treatment of Parkinson's disease," said Galit Kleiner-Fisman, MD, department of neurology, University of Toronto, Ontario, Canada. "We wanted to know if patients with a prior pallidotomy should be considered for a second surgery. We found that patients with this history had similar outcomes and similar benefits to de novo patients." The investigative team was interested in the potential benefits of bilateral STN DBS for patients with a prior unilateral pallidotomy because some patients experience a progression in symptoms after the initial surgery. Dr. Kleiner-Fisman said that this exacerbation of symptoms does not indicate that the prior pallidotomy was unsuccessful, but rather that the disease had progressed. Dr. Kleiner-Fisman and his co-investigators wanted to determine whether such patients would experience a clinical benefit from bilateral STN DBS, whether there would be a difference between the two sides, and whether the results would be comparable to those seen in de novo patients. The investigators followed 7 patients with prior pallidotomy who underwent bilateral STN DBS. The parameters of the study included changes in their scores on the Unified Parkinson's Disease Rating Scale (UPDRS), motor and activities of daily living (ADL) scores, their medication requirements, and dyskinesia, which the investigators compared to those of de novo patients. The investigators also compared the individual patients' side-to-side changes in tremor, bradykinesia, and rigidity. Patients experienced significant benefits from surgery, the investigators reported. UPDRS motor scores declined 42.1% (P = .03), a reduction equivalent to that seen in de novo patients (41%, P < .001). The changes in ADL scores, medication requirements, and dyskinesias were less dramatic, the investigators reported. They noted no side-to-side difference in patients' tremor, bradykinesia, or rigidity. Dr. Kleiner-Fisman emphasised that the previously operated patients had better baseline function than did the de novo patients. Those for whom STN DBS was a second surgery experienced less change in dyskinesia duration and disability than did the de novo patients (P < .017 and P < .005, respectively). "These findings show that a prior pallidotomy should not preclude a patient being considered for deep brain stimulation surgery," Dr. Kleiner-Fisman said. [Study Title: Bilateral STN DBS For Parkinson's Disease after Successful Pallidotomy. Abstract 203] SOURCE: Doctor's Guide (press release) http://tinyurl.com/uf5o * * * ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn