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The following criteria have recently been published in the PD Update Newsletter Issue 48. They are based on published results from centers that have performed pallidotomies in the last year. In addition respected leaders in Neurology and Neurosurgery have given their verbal input. The comments below are to be considered only as suggestions for review of centers offering pallidotomy. They in no way are inclusive or exclusive and offer no guarantee of successful outcome. PALLIDOTOMY IN BRIEF "Pallidotomy" is a term referring to the surgical destruction of a group of cells deep in the brain accessed through a small hole in the skull. The goal of pallidotomy is to reduce or control parkinsonian symptoms such as rigidity, tremor, and dyskinesias (involuntary movements caused by levodopa). Though sedated, the patient does not need general anesthesia for the procedure, allowing feedback during the actual surgery and reducing the risk of complications. WHO IS A CANDIDATE ? The procedure is most likely to benefit the parkinsonian patient who initially had a good response to Sinemet therapy, but may have developed on/off fluctuations that are difficult to control with medications alone. It is not a reasonable alternative for patients whose symptoms are well managed by anti-Parkinson medications. It is not appropriate for patients who suffer from memory loss, confusion or disorientation. Patients should have realistic expectations. At it's best the surgery does not cure Parkinson's disease. Even patients with marked reduction in their symptoms still require anti-Parkinson medication. WHERE IS THE SURGERY DONE ? The recent television documentary implied that one neurosurgeon in Southern California had "discovered" this new procedure, almost representing it as a cure for all Parkinson symptoms. This is inaccurate. A number of movement disorder centers in the U.S. and Europe have been doing this surgery for several years. Due to sophisticated new brain imaging and mapping techniques, more surgeries are now having impressive results. Lists of centers doing pallidotomies are available through local Parkinson's Disease Support Groups and national organizations. In addition, many major academic medical centers are acquiring the tools to perform pallidotomies in a safer manner. HOW DOES ONE CHOOSE A NEUROSURGICAL CENTER ? Any patient interested in being evaluated as a candidate for Parkinson surgery should take great care in selecting a center with adequate expertise and experience doing such procedures. The following selection criteria are recommended: 1) Neurosurgeons should be board-certified and experienced in stereotactic surgery. They must have experience performing thalamotomy and pallidotomy for Parkinson disease. There should be a dedicated stereotactic operating room with equipment for intraoperative recording. A neurophysiologist should be available during the surgeries to supervise single-cell intraoperative recording. 2) The center must have the capability of doing Magnetic Resonance Imaging (MRI) and optimally, Positive Emission Tomography (PET) to perform brain scans and precisely locate the exact placement of the surgical lesion. Neuroradiologists on staff must have experience with MRI in Parkinson patients undergoing stereotactic surgery. 3) The medical staff should include board-certified neurologists who specialize in movement disorders, and devote at least 75% of their clinical practice to the diagnosis and treatment of Parkinson disease. These physicians should be experienced using standardized Parkinson measurement tools such as the Unified Parkinson Disease Rating Scale and the AIMS scale, interpreting levodopa blood levels, computerized quantification to evaluate tremors and other abnormal movements, and videotape logs of patient progress. 4) The center should be actively involved in clinical trials sponsored by acknowledged international pharmaceutical corporations to evaluate experimental drugs for the treatment of Parkinson disease. Desirable credentials for a center include membership of the neurology staff in the International Movement Disorder Society and the Parkinson Disease Study Group in the U.S. 5) Doctoral level neuropsychologists should be on staff to conduct comprehensive neuropsychological tests prior to and following the surgery for Parkinson disease. While these criteria will increase the chances of successful outcomes they do not represent a guarantee of any kind. /================================================== / Matthias C. Kurth, MD,PhD Tel #: 602-406-3434 / Barrow Neurological Institute Alt #: 602-406-6315 / Movement Disorders Specialty Clinics / 222 West Thomas, Suite 401 FAX #: 602-406-7187 / Phoenix, Arizona 85013 E-MAIL: [log in to unmask] /==================================================