Michelle Ehrlich,
Here is my best explanation of the Pallidotomy.
A Parkinson Pallidotomy Primer
compiled & summarized
by Don Berns
BRIEF HISTORY
Globus Pallidus
Years ago observant doctors noted that Parkinson patients who had a
stroke in a particular area of the brain experienced some relief
from their symptoms.
Animal Model
With the serendipitous discovery and identification of MPTP (Dr
Langston, San Jose, CA early 1980's) as a parkinsonian inducing
chemical, research scientists had the means for creating a
parkinsonian animal model.
Research
Through pursuant studies researchers noted that one of the critical
abnormalities in animal models of Parkinson's disease is an
increased amount of electrical activity in the globus pallidus of
the brain. By cutting the pallidofugal fibers as they travel from
the globus pallidus to the thalamus the abnormal signal causing the
signs and symptoms of Parkinson's disease is short-circuited.
Explanation
To understand how a pallidotomy works think of the brain as
containing a series of interconnected electrical circuits. In the
parkinsonian one of these circuits is overly active because there
is not enough of the neurotransmitter dopamine to regulate the
electrical activity. A lesion (small hole)is created on the
electrical pathway between the globus pallidus and the subthalamic
nucleus. Thus, using this metaphor, the overly active circuit is
cut.
THE PROCEDURE
Technique
Through a procedure technically known as a Postero-Ventral
Pallidotomy, a probe will be inserted into a very precise location
of the globus pallidus approximately four inches beneath the top of
the head. The patient remains conscious under a local anesthetic.
When the probe is in the correct position, immediately adjacent to
the optic nerve a small electrical charge will be transmitted to
the tip of the probe.
If the probe is too deep the patient will experience his/her very
own fireworks display and the probe will be slightly withdrawn.
When it is properly located there will be a slight twitch in the
cheek or tongue. At that moment heat will be generated to the
probe tip and a small lesion will be created.
Explanation
A simplistic explanation is this procedure creates lesions of
pallidofugal fibers leaving the globus pallidus on the way to the
thalamus. Rough Translation - An overly active neuronal pathway
which results in abnormal and extra-kinetic movements, is severed.
Although the Pallidotomy is not a cure it can eliminate many of the
manifestations. The results are instantaneous and appear to be
long lasting.
History
Similar surgical procedures have been available since the early
1940's, however refinement in surgical technique, increased
knowledge, the development of a parkinson induced animal model, and
monumental advances in technology (CAT scans and MRI's), now enable
very precise identification and hitting of the target in the globus
pallidus.
Dr Robert Iacono (Loma Linda University Medical Center)
states, "The beneficial effects of Postero-Ventral Pallidotomy on
akinesia, postural instability, stooped posture, freezing, on-off
phenomenon as well as tremor, rigidity, dystonia and dyskinesia are
superior to the results reported for fetal graft implantation, best
pharmacologic results, or conventional stereotactic procedures." 1
Dr. Lauri Laitinen in Stockholm, Sweden, uses CAT scans for
locating target area. CAT scans are not as precise as MRI used by
doctors in U.S.
In 1952, Dr. Lars Leksell in Lund, Sweden began to perform
anterodorsal Pallidotomies, but the results were not satisfactory
and he gradually moved his target area to the Postero-Ventral part
of the Pallidum. In so doing Dr. Lars Leksell moved the
Pallidotomy outside the classic anterodorsal target area.
Dr. Lars Leksell in addition to this pioneering work also is
credited with developing the first Gamma Knife. The Gamma Knife
creates the Pallidotomy lesion by using high-powered focused
radiation beams.
Between 1985 and 1990 Dr. Lauri Laitinen & Associates tested
Dr. Lars Leksell's Pallidotomy procedure on 38 Parkinsonian
patients, using stereotactic Postero-Ventral procedures as opposed
to Gamma Knife or anterodorsal classic procedures.
"Upon re-examination 2 to 71 months after surgery (mean 28
months) complete or almost complete relief of rigidity and
hypokinesia (slowness of movement) was observed in 92% of the
patients. Of the 32 patients who before surgery also suffered from
tremor, 26 (81%) had complete or almost complete relief of tremor.
The L-dopa induced dyskinesia and muscle pain had greatly improved
or disappeared in most patients, and gait and speech difficulties
also showed remarkable improvement."
"The positive effect of Postero-Ventral Pallidotomy is believed to
be based on the interruption of some striopallidal or
subthalamopallidal pathways, which results in disinhibition of
medial pallidal activity necessary for movement control." 2
COMMENTS BY THOSE WHO HAVE HAD PALLIDOTOMIES
Bill Dickinson: Fullerton, CA
Date of surgery: Aug. 8, 1993
Hospital: Loma Linda Medical Center
Doctor: Dr. Iacono
Procedure: Pallidotomy (right side)
Life with Parkinsons: 6-7 yrs.
Before surgery: Freezing episodes, 1/2 hr. periods of
mobility,homebound to chair, lost 30-40 pounds, excessive
sweating, sleep perhaps 1-2 hr at night, bothered by dyskinesia. L-
dopa intake 1800 mg/day.
After surgery: "It has given me a whole new life." Able to return
to work in mornings, go out to lunch, and play golf in afternoon.
First two weeks in October left on a trip for Europe with his wife.
Reduced L-dopa intake to 1200mg. so far.
Brian Keane from New Zealand:
Date of surgery: Oct. 27, 1993
Hospital: Loma Linda Medical Center
Doctor: Dr. Iacono
Procedure: Pallidotomy (one side)
Life with Parkinsons: 5 yrs., freezing bouts
Before surgery:"Before surgery I was unable to care for myself
independently- bathe, shave, shower, eat etc. Now I am able to do
all these."
After surgery: "Overjoyed!! The surgery has been a wonderful
experience. There is really nothing to be afraid of." (Four days
after surgery)
Jack Pickens- Niceville, FL
Date of surgery: Nov. 17, 1993
Hospital: Loma Linda Medical Center
Doctor: Dr. Iacono
Procedure: Pallidotomy and Thalamotomy (same side)
Before surgery: Had Parkinsons for 5-6 years. Now 68 years old.
Tremor, stiffness, and dyskinesia.
After surgery: Thrilled, delighted. "I can't believe it. I can't
believe it." Tremor gone. No dyskinesia. Side no longer stiff and
unflexible. Taking great delight in being able to move his body as
he chooses.
Don Berns- La Canada, CA.
Date of surgery: Dec. 1, 1993
Hospital: Loma Linda Medical Center
Doctor: Dr. Iacono
Procedure: Bilateral Pallidotomy (both sides)
Life with Parkinsons: 12 1/2 yrs.
Before surgery: Bothered by dyskinesia, bradykinesia, akinesia,
sweating, and tremors.
After surgery: Ecstatic, Feels like I'm almost in a fantasy land,
but with each passing hour the fantasy becomes more a reality and
what was the Parkinsonian reality becomes a fantasy.
The bilateral Pallidotomy seems to be a complete success. I no
longer am plagued with stiffness, immobility, tremor, excessive
sweating, akinesia, bradykinesia, dyskinesia, walking difficulties,
stooped posture, swallowing difficulties, or speech hindrances. My
eyes and mouth remain shut at night while I sleep rather than both
remaining partially open. There is no longer an "on-off" phenomena.
My voice is strong again. My face is expressive and noticeably
different. I no longer have a sense of urgency when I need to
urinate. I do not need to lie down for 3 hours in the afternoon
because my body is so slowed down. I now sleep through the night
and no longer take a sleeping pill before I go to bed to help me
try to get a good night's sleep. My appetite has returned and
eating is a joy rather than a chore. Both my arms swing freely when
I walk. My gait is loose and normal. Karen says my hand feels soft
and pliable, rather than stiff and tense. I move about easily,
freely and naturally.
DOCTORS PRESENTLY PERFORMING PALLIDOTOMIES
The following neurosurgeons are actively performing Pallidotomy
surgery in the US. All come highly recommended by Dr. Lauri
Laitinen of Sweden. They were most likely trained by him.
Michael
Dogali MD
212 598-6300
New York
Antonio
DeSalles MD
310-794-1221
UCLA
Los Angeles
Peter Heibrun
MD
801-581-6908
U. of Utah Salt Lake
City
Robert Iacono
MD
909-796-4822
Loma Linda
Univ. Med.
Ctr.Loma Linda,
CA
David Roberts
MD
603-650-8736
Dartmouth
Univ.Med.
Lebanon, NH
M. DeLong MD Emory
University Atlanta,
Georgia
Rush
Presbyterian,
Chicago, ILL
A 30 minute video documentary is now available entitled
NEW HOPE FOR PARKINSON'S DISEASE - The Stereotactic
Pallidotomy Technique.
The cost is $24.95, including shipping, handling, and a
$2.00 contribution to the Loma Linda Med. Ctr. Parkinson's
Research Fund.
Send check to: Road Trip Productions
P.O.Box 268
Altadena, CA 91003-0268
Don Berns <[log in to unmask]>
