To All
In June 1994 a member of the Parkinson Foundation of Canada spoke to our
Chapter about his successful Pallidotomy. The article reproduced below
was written for our local Newfoundland newsletter to answer some of the
questions of Chapter members who missed the presentation.
I have not posted this before because I am not a doctor, nor a
scientist. My purpose in posting at this time is to provide some basic
information about this procedure without being "for it or against it".
Please don't flame.
Regards,
Anne Rutherford,
St John's Newfoundland
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Extract from
The Centre Page * Newfoundland Newsletter * Summer1994 v5 n2
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Pallidotomy
In these few paragraphs I will try to give you an idea of the history
and the theory of the pallidotomy as well as a picture of what actually
happens during the procedure. I have been lucky to have had the
opportunity to talk to 3 people who have had this operation and read
several of the articles and letters written about the experience. Other
sources include material in the chapter files and postings to the
<Parkinsn Disease Information Exchange Network>. I will try to avoid
using long and technical words and will define the words I must use in
the WORD LIST which follows. (not included)
This operation is not for everyone, and while some medical people are
very positive others prefer to wait and observe the long term outcomes.
This is not an entirely new operation. In the 1960s and before some
Parkinson patients had brain surgery (including pallidotomy), but after
L-dopa was approved as a Parkinson drug these operations became rare. A
few neurosurgeons continued to operate for the relief of tremor.
Today's pallidotomy differs from the earlier operation. CAT and MRI
scanners are now used to see inside the head, to direct the probe and to
pinpoint the target area. Also, due to research findings in the 1980s,
the lesion is now made in a slightly different place in the Globus
Pallidus The full name of the modern operation is
Postero-Ventral-Pallidotomy (PVP).
The theory (much simplified) is that in the Parkinson patient one of the
control centres in the brain is overactive. This causes many of the
symptoms. When a very small lesion is made in this exact area the
patient's brain can run things properly again and many symptoms will be
lessened.
Usually the PVP is done on one side of the brain. If necessary the other
side can be done later.
The surgical team is led by a neurosurgeon using stereotactic techniques
who has had further training in this procedure. The operation is done
in Sweden and at 10 or more medical centres in the USA. In Canada, a
series of pallidotomies is underway at the Toronto Hospital's Movement
Disorder Clinic. Other Canadian medical centres are planning to begin.
Only 10-20% of people with Parkinsons are suitable candidates for a
Pallidotomy and each clinic has its own guidelines for selection, such as
severity of symptoms, age, other medical problems, etc. The waiting time
may be as long as a year or as short as three months.
The procedures described below are based on the stories of the three
patients I have met.
-Before the operation the patient performs various tests of mobility and
a videotape is made to compare to a similar tape which will be made after
the operation.
-The day begins with a visit to the CT or MRI for a brain scan.
-Anti parkinson medications are stopped before and during surgery.
-There is no general anesthesia as the patient must be able to hear,
understand and act on the instructions of the doctors.
-The stereotactic frame is fastened to the head with screws so that it
will not move. This frame assissts in positioning the probe.
-During the operation the frame is also fastened to the operating table.
-At the point indicated a small (less than halfinch) hole is made in the
skull (with local anesthesia) through which the probe is inserted.
-The operation usually takes less than 2 hours but in the Toronto
procedure data from the brain is recorded as the probe moves through
different locations. This takes more time but adds to our knowledge of
how the brain works.
-When the probe reaches the preselected target point various tests
determine that it is in the best possible site. It is essential that the
patient be alert at this time.
-The surgeon uses heat to make a tiny lesion when he is satisfied that
everything is in order. Within an instant Parkinson stiffness vanishes. .
-The initial recovery is fast. But the patient should wait several weeks
before resuming normal activity.
The End
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