This is the forwarded comments from Dr. Lieberman to the New York Time, Letter
to the Editor page.
THE COMPLETE TEXT OF Dr. Lieberman's LETTER TO THE EDITOR FOLLOWS:
March 20, 1995
Editors, New York Times
New York, New York
Dear Editors:
The March 16, 1995 Times article on pallidotomy, a surgical treatment
for
Parkinson's disease, differed markedly from the recent Wall Street Journal
article on the same procedure. The Journal article was positive, your article
was negative. Why the discrepancy?
The answer, not emphasized in either article, is patient selection and
operative technique. Pallidotomy as a treatment for Parkinson's disease is
fifty years old. The resurgence of interest is due to improved methods of
locating. But even after it is located, pallidotomy is not tonsillectomy or
herniorrhaphy. It cannot be done in any hospital by any surgeon.
Patient selection is important. A surgeon quoted in your article
couldn't distinguish Multiple Sclerosis from Parkinson's disease. If he
couldn't distinguish the two he shouldn't have done the procedure. But what
about the more difficult task of distinguishing between Parkinson's disease and
the look-a-like disorders such as Progressive Supranuclear Palsy? Striatonigral
Degeneration? Multi-System Atrophy? Such distinctions are necessary because
the look-a-like disorders don't respond as well as Parkinson's disease to
pallidotomy.
The pallidum is located using high field Magnetic Resonance Imaging
(MRI), a technique available almost anywhere in the United States. But locating
the pallidum is not enough. The pallidum must be distinguished from the
adjacent internal capsule. Failure to do so results in stroke. The pallidum
must be distinguished from the adjacent optic tract. Failure to do so results
in partial blindness. The internal pallidum must be distinguished from the
external pallidum. Failure to do so results in increased, not decreased
Parkinson symptoms. Finally the topography of the internal pallidum must be
mapped and its volume determined. Failure to do so results in only partial
relief of symptoms.
The pallidum is distinguished from its surrounding structures, the
internal is distinguished from the external pallidum and the topography of the
internal pallidum is defined through single-cell, intra-operative recordings
performed by a trained neurophysiologist. The difference between doing the
procedure with monitoring and without is the difference between the results
described in your article and the Journal's article.
Truly,
Abraham Lieberman, M.D.
Chairman, Medical Advisory Board
American Parkinson Disease Association
Chief, Movement Disorders
Barrow Neurological Institute
Phoenix, Arizona,
John Cottingham [log in to unmask]
