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In article virginia tilley <[log in to unmask]> writes: >A problem related to eligibility for pallidotomies: my mother was recently >evaluated for a pallidotomy and told that she wasn't sufficiently bad off. >That is, Sinamet seems to be controlling her tremor enough to exclude her from >consideration. >The problem is that we believe the Sinamet is greatly aggravating >her mental confusion. She can't keep track of time, she asks questions over >and over, she hallucinates, is withdrawn and without motivation--all very >opposite to her former personality. Her life is reduced to the house, and her >husband is under enormous pressure. She is miserable. I can't help but feel >that the specialists in Philadelphia ignored or were oblivious to this >dimension of life with Parkinson's. I understand that post-pallidotomy Virginia, I know it is hard to accept but the pallidotomy is a "fly by the wire" procedure and requires an alert coherent patient on the table. In the stimulation phase of the procedure, the brain is stimulated with a small voltage and the patient has to tell the surgeon where they are feeling it if it is not evident by observation. Those that have had it have said the right spot for the lesioning is when the stimulation causes a tingle along the jaw. The surgeon obviously couldn't rely on your mother to give him good feedback at the critical time in the procedure. >I am frustrated that the medical thought about pallidotomy does not >seem to consider that tremor alone is not the only problem, >that the drugs can be ruinous, and getting off of them a >major goal. If they even acknowledged the problem their ultimate judgement >to refuse pallidotomy would seem more acceptable, but it seems that they >don't even think about it. Controlling tremor appears to be the goal, and >everything else (like mental incompetence) a relatively minor side issue. >Never mind that the "relatively minor side issue" has become an all-consuming >worry and round-the-clock job for all those around her. Pallidotomy is not as effective for tremor as some of the other procedures. Does the caregiver keep a diary? What meds is she on? Has the neurologist ever described her condition as having Parkinson's Plus features? John Cottingham NEW ADDRESS: [log in to unmask]