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Virginia Controlling the tremor is not the goal of Pallidotomy. Pallidotomy is supposed to help rigidity, freezing, drug induced dyskinesiae and some aspects of the gait disorder. Mental incompetence suggests dementia and is a contraindication to pallidotomy. It is also unlikely that Pallidotomy will allow someone to totally get off Sinamet. In addition, age is also a negative factor in Pallidotomy which seems to have better results in younger individuals than in those over age 70. Too many patients and their families are seeing Pallidotomy as the holy grail-the only hope for the end to their suffering-the cure for Parkinson's disease. It is none of these. In selected patients it's a good operation for a finite set of symptoms. It does not cure the disease. And it is not appropriate for everybody with Parkinson's disease. Thalamotomy is very specific for the treatment of Parkinson's disease tremor, but does little or nothing for the other symptoms of the disease. However, the risks of thalamotomy increase to (in my mind) unacceptible levels in patients over age 70. A surgeon can operate on anyone. Judgement on whether or not to do a surgical procedure depends on his (or her) assessment of the risk/benefit ratio. If the benefit is low and the supposed risk is high, surgeons should not do the procedure. As I said a surgeon can operate on anyone-and derives income from operating. The surgeon's success depends for a large part on how well he is able to assess the risks of the procedure preoperatively. It is the patient and his or her family who must live with the results of that decision if the surgeon guesses wrong and a complication occurs following surgery. Hope that this information helps. PJ Kelly \--------------------------------------------------------------\ \ Patrick Kelly, MD \ Internet: [log in to unmask] \ \ NYU Medical Center \ Phone: (212)-263-8002 \ \ New York, N Y \ \ \ \ \ \--------------------------------------------------------------\