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Amy Strizak wrote: >> My grandmother on the other hand was just diagnosed with PD >> about 2 years ago and still a pallidotomy has never been discussed with >> her. What exactly does a pallidotomy entail and why do you think that >> the doctors have never discussed this with anyone from my family? Amy: There are other people on this list that will be better able to explain pallidotomy than I am, but basically it works like this: The hallmark of PD is a dopamine deficiency (and traditional therapy has focused on replacing the missing dopamine through medication). One of the things dopamine does is regulate the activity of a part of the brain called the pallidum, and when there's not enough dopamine, the pallidum gets hyperactive. It seems likely that some of the major symptoms are caused by this pallidal hyperactivity. The pallidotomy is an operation that basically kills some or all of the pallidum. As to why your mother didn't know about it... I can think of three possible reasons: 1. Some physicians (even neurologists) don't seem to know much about it. My mother was being seen by a neurologist we considered to be excellent (he'd helped her a lot) who agreed to refer her to Emory University for evaluation as a pallidotomy candidate. In his referral letter, he said she was "interested in seizure surgery" (!!!), which is not the same thing at all! 2. Some people are reluctant to recommend any irreversible operation that kills part of the brain. 3. Not all PD'ers are good candidates for pallidotomy. To quote a letter I received from a PD specialist: "The people who have benefited from the surgery are those who have developed PD at a young age, 30s - 40s, have tremor and have been on Sinemet for greater than 10yrs. This is probably about 5% of people with PD. People who develop Pd in their 70s and older are not appropriate." I've heard other neurologists (more than one) add these other criteria: a. The patient originally did well on Sinemet but doesn't do so well anymore. b. The patient experiences a severe "ON/OFF" phenomena. c. The patient doesn't have dementia or "parkinson plus" symptoms. I'd suggest bringing up the subject with your mother's neurologist. If she hasn't seen a movment disorders specialist, she needs to. You might also contact one of the national PD associations, like the APDA for suggestions. (They have lists of movement disorders specialists and centers that perform pallidotomies.) There's another similar procedure that involves implanting an electrode into the pallidum. This procedure doesn't kill tissue (at least not as much), but allows the patient to "turn off" the pallidum electronically to relieve symptoms. I know there was some research being done in the U.S. awhile back, and I know of people who've had it done in Europe, but don't know whether this operation is being done much in the U.S. right now. Anyone else? Hope this helps. I'll be interested in reading the other responses as well.