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>Date: Sun, 9 Oct 1994 08:35:40 -0700 >From: [log in to unmask] (Robert Fink) >Subject: Fwd: Pallidotomy, Some Questions Mark: Your concerns and questions are valid. Pallidotomy (or other surgical procedures on the brain) do *not* correct the biochemical deficits thought to be the cause of PD (and other abnormal movement disorders), but rather, by interrupting "normal" nerve pathways, they can "block" some of the symptoms. Thus, creating lesions (areas of tissue destruction) in the motor pathways (called the "extrapyramidal system" as opposed to the "pyramidal system" which controls voluntary movement), can decrease or eliminate some of the motor manifest- ations of PD; but the *other* symptoms, such as the "slowness", the mental deficits, the drooling, etc., are not purely motor phenomena, and thus, are often not helped with the operations. The "other" aspects of the disease (presumably caused by the dopamine deficit), continue to progress independent of the surgery. Interruption of the nerve pathways is akin to cutting a nerve in order to relieve pain (and this is justified at times); but the *condition causing the pain* is not affected. This kind of surgery dates back to the early sixties when Dr. Irving Cooper, in New York City, discovered "by accident" during another surgery then popular for PD, that a lesion in the globus pallidus (part of the deep structures of the brain) would decrease or eliminate the tremor of PD; and he and others developed other operations designed to do this. I was trained in this field in the mid sixties, and I have performed many of these operations, this during the period of "popularity" which essentially ended with the discovery of L-DOPA and the other drugs by Cotzias. The drugs also have their limitations, and their effects are often temporary; but this is also true with the surgery. The surgery, as "brain surgery" goes, is not particularly risky in good hands although there are, as with any major operation, some risks, which have been honestly described here. My objection to the apparent "push" for pallidotomy on this List is not the risks, but the "effectiveness" of the operation. It is by no means a "cure" for PD. This kind of surgery is not being done with much frequency in the USA (except for certain centers such as Loma Linda); and my understanding of why this is the case is that most academic people do not feel that it is particularly helpful in the vast majority of cases of PD. The surgery is more popular in Europe, as several of the doctors who, in days gone by (such as Drs. Leksell and Laitinen) were pioneers in stereotactic surgery and got "very good at it". I do not dispute the skill of these doctors; it is the concept of the operation that I have reservations about. Best wishes, Bob -- ******************************************************** Robert A. Fink, M. D., F.A.C.S. Phone: 510-849-2555 Neurological Surgery FAX: 510-849-2557 2500 Milvia Street Suite 222 Berkeley, California 94704-2636 USA E-Mail: [log in to unmask] CompuServe: 72303,3442 America Online: BobFink "Ex Tristitia Virtus" ********************************************************