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My doctor has requested that I go to Toronto Western Hospital for a consultation for a pallidotomy. In the meantime, I have some questions and would appreciate all responses, thoughts, etc. as some decisions will have to be made. I am a bit confused regarding several types of surgical procedures: a) Pallidotomy - A lesion is created in the globus pallidus and is usually done on one side because of the risks of speech and swallowing difficulties. It reduces certain symptoms of PD and does not appear to reduce the medication in most. Also in one specific case a person who had a Pallidotmy in June 95 has some of the symptoms returning. Is this the same procedure in which a lesion is placed in the posterventral part of the inner Globus Pallidas? Is this the same procedure in which the PAMIDOFUGAL fibers are cut where they travel from the globus pallidotomy to the thalamus. This shorts out the over active neurons? Is there other locations that a lesion could be placed and be as or more effective? b) Thalamotomies - Is effective in reducing tremor only and this procedure a lesion is created in a specific region of the thalamus that coordinates the activity of motor and sensory commands. It is part of the major neuronal "highway". Only one side is usually done because of risk. c) VIM - Just like thalamotomy however instead of a lesion an electrode is implanted and an impulse generator is implanted. d) Pallidal Stimulation - A pulse generator is implanted in the patients chest and electronic pulses are sent to electrodes implanted in the globus pallidus. e) Deep Brain Stimulation - An electrode is implanted in the thalamus pallidum and a pulse generator sends out electronic pulses. It is very effective in treatment for tremor only. In France they have had good results in implanting this devise in the subthalamic region. f) Bilateral Chronic Electrostimulation of ventroposterolateral pallidum. It alleviates all P.D. symptoms (Germany). Which operation will give me the best results with the least risk? I understand that all of these operations are only to buy time until a cure can be found as PD is progressing. Also which of the above are available in Canada and if not are they accessible to me? Also the costs are critical. I am on approx 1300 mg of Sinemet and 3 or 4 mg of Permax and the effectiveness of these drugs are rapidly decreasing. So with a very small therapeutic window it is becoming more difficult to avoid dyskinsea. Dan McNeill e-mail address: ([log in to unmask]