I have noted a number of requests from people wanting information as to
what qualifies a person as a good candidate for a Pallidotomy or Thalamotomy.
Perhaps jumping in where angels fear to tread I would offer the following
observations concerning the medical qualifications for a Pallidotomy based on my
experience working closely with Dr. Iacono in the Parkinson s clinic at Loma
Linda over the last 16 months. .
There are three basic categories of Parkinson s patients.
Parkinson s Type A
characterized by tremor, widespread fluctuations, on-off , sinemet
responsive, dyskinesia, very little balance problems, no falling, and is
generally found in early-onset patients.
Parkinson s Type B
characterized by balance difficulties, frequent falling, not very
responsive to sinemet, little or no tremor, weakness, generally in off state
as opposed to on , little fluctuation or variance in symptoms. Usually found
in older patients.
Parkinson s Plus
Parkinson s symptoms occurring with other symptoms reflecting dysfunction
in the cerebellum or other parts of the nervous system. Included in this
category would be olivopontocerebellar atrophy (OPCA), progressive
supranuclear palsy (PSP), Shy-Drager Syndrome.
Of these three broad categories those with Parkinson s Type A are the
most responsive to surgery. Those with Parkinson s Plus are the least
responsive. With Parkinson s Type B falling in between the two. However having
said this there are exceptions and some Parkinson s Type B patients have had
equally good results as Parkinson s Type A.
95% of the Pallidotomy patients at Loma Linda are pleased with the
results and experience significant improvement. The results I would say range
from a C+ to an A+. With a C+ finding relief from two or more symptoms and A+
experiencing relief from all symptoms. What makes the difference between the C+
and A+? A whole host of reasons some known and some unknown.
Known factors are those patients :
****with a good attitude
****in otherwise good health
****on an effective medication schedule before surgery
****who are able to communicate effectively with the doctor
during surgery
****who are bathed in the prayers of loved ones
****and of course most importantly, how close the surgeon is able
to come to the target.
Finally a Thalamotomy should be considered by those patients for whom
tremor is the primary presenting problem, realizing that a Thalamotomy will only
relieve the tremor. It is 95-100% effective in relieving the tremor on the
contralateral side (opposite side from the surgery).
A Pallidotomy will generally relieve 70-90% of the tremor and it will
provide relief from some or all of the rest of the Parkinson s symptoms. To my
knowledge Dr. Iacono stands alone in doing simultaneous bilateral (both sides)
Pallidotomies. He has done over 50 simultaneous bilateral Pallidotomies.
I hope this information, which will not be unanimously agreed upon by all
who subscribe to this list, provides the beginning basis for more dialogue on
this important issue of the qualifications for a Pallidotomy/Thalamotomy.
Don Berns <[log in to unmask]>
P.S. My kudos to Alan Bonander for his comments the other day as a strong
patient advocate.
