 |
 |
To Pallidotomy or not to Pallidotomy; That is the question ...and the rub. A lot of people swear by the procedure, and will tell you it is the only way to go. But before we all start cashing in our Bonds for tickets to Loma Linda or Sweden, why don't we take a closer look at this procedure with a more pragmatic and less emotional viewpoint ...similar to what Mr. Devor of Israel tried to do (more on this later). Here are some published facts: This "new procedure" was "discovered" by a serendipitous slip of a scalpel in 1937, which developed into a procedure called "stereotactic surgery" By 1940, 39 out of 100 operations performed are credited to bringing relief of contralateral involuntary movements without causing any neurologic defect. Some of the remaining patients in this series suffered partial paralysis (paresis) or seizures. Seventeen died. (See Irving S. Cooper, "A Review of Surgical Approaches to the treatment of Parkinsonism" "The Neurosurgical Alleviation of Parkinsonism - published 1956, page 7) This whole story in detail is published in "Parkinson's Disease: The Mystery, The Search, and the Promise" (pages 42 - 54) ISBN 0-9620354-1-6 and is available from Pixel Press, P O Box 3151, Tequesta, FL 33469, USA, for $16.95 US currency. Add $4 for shipment outside North America. The book is 230 pages, extensive bibliography, indexed, illustrated, and a Historical Chronology from 130 AD thru 1992. Telephone orders via BookWorld Services, 1-800-444-2524 In 1967, Sidney Dorros, well known in PD circles prior to his death in 1993, had the operation on one side. After historical consideration of the effects, he opted against the second surgery. Margaret Bourke-White's ( "Life Magazine's" famed photographer) surgery on the other hand was considered very successful as she regained the use of her left hand and arm. But it also brought other complications in depth perception and walking. At one point, I considered this procedure. I am a Parkinsonian of 15+ years ...it is difficult to pin-point the onset as PD is so insidiously slow. After some investigation in detail for a period of time, I, like Sidney, opted out. I have been quietly studying this problem, and through private interchanges, have come to the conclusion that Pallidotomys have a very poor cost to benefit ratio. One noted Research MD/PhD deeply into the field of Parkinson's told me, frankly, that Pallidotomys are deliberate mutilation of brain tissue for a temporary Band-Aid fix, and many people have written me about the effects of the procedure wearing off in time spans that range in years to 4 months (One contributor to this list tells me a considerably different story about the staying power of his Pallidotomy than he writes about on this list). It is not a cure. It is not a permanent fix. It is an expensive Band-Aid. Lets look at some more real pictures of this procedure: 1. PD patients who have had Pallidotomys can be automatically disqualified from future (and possibly, more fruitful and longer lasting) procedures simply because they no longer have a "virgin" brain. This has already happened in two studies I know of ....and there are probably more I do not know about. Researchers are not happy with complications to their data. 2. The area of the brain where the leisions are placed is VERY close to the optic nerve. 3. Overall, the "track record" of Pallidotomys over and after two years are not all that good statistically. I read Mr. Devor's excellent breakdown with considerable interest. There is some confusion (Using "case numbers" ) as to what statistical sample belongs where. Provided 165 records. 1 backed out; 1 didn't need the procedure; 11 were listed twice; 3 had known results; 2 cancelled; and 33 were not available. That leaves a total sample population of 114. Mr. Devor spoke to 113. Out of the 113, 1 hung up; 1 gave no detail; 32 lost mobility; and 46 felt they were not helped. That is a total of 80, that, presumably, were negative about the procedure out of a population of 113. If my numbers are correct (and they may not be because of the way "case" numbers were used) that is 70.79% against and 29.21% for Pallidotomies. As this ratio seems outrageous, lets assume just the quoted comments are correct. That means 9 were not helped. That ratio is 7.96% against to 92.04% for the procedure. My inputs tend to look higher than approx. 8%, but even if it is only an 8% failure rate, and considering a lot of the relief does wear off in time, and you would possibly be precluded from participation in future studies, that number is too high for me (ask yourself, "Would I fly in a Shuttle with only a 92% reliability?) Pallidotomies may be the perfect thing for the desperate and aged. It is a very individualistic decision. For those that have had the procedure, and are happy with the result, I am pleased for you. It is not a waiting line you are likely to find me standing in. VernD