>>> Robert Mcguire <[log in to unmask]> 05/28/97 10:57am >>> what is pallidotomy? bob mcguire [log in to unmask] Robert - From the 1930's through the early 1960's doctors used surgical lesions in the pallidal regions [movement control centers] of the brain to relieve some of the symptoms of Parkinson's disease. However, clinical research took the stage in the 1950's and doctors discovered that the neurotransmitter dopamine was involved in the symptoms of Parkinson's. Medical therapy, L-dopa, became the treatment of choice. After 10-15 years the doctors realized that L-dopa began to lose its beneficial effect leading to adverse effects such as dyskinesias (rigidity of muscles) and "on-off" fluctuations in the patient's ability to move normally. Interest in surgical interventions was rekindled in the 1970's. New neurosurgical techniques using CT (cat) Scans, MRI and PET scans allows surgeons to accurately target the areas of the brain for a localized lesion of the ventral globus pallidus - "Pallidotomy" - (usually uni-lateral: left or right side) to alleviate movement disorders (severe tremors, rigidity and bradykinesia/slowness) not treatable with medication. Not all patients are candidates for the surgery. A patient should not be suffering from dementia or depression and must be "responsive" to levodopa therapy. The operation can last up to 10 hours with the patient awake (the brain feels no pain) except for local anesthetic and secured to a metal frame on their head. Some surgeons report an 80% reduction in dyskinesias after surgery which allows patients to resume pre-operation levels of medication, without adverse effects. Long term effects of the procedure are still under evaluation. Because the surgery involves the brain, a very tricky area to operate in, adjacent motor areas for vison and movements have been compromised in about 5% of the surgeries, leading to blindness and/or paralysis. Many neurologists feel that destroying more areas of an already damaged brain is counter-productive. Rather, they would like to implant and re-populate the dopaminergic nerve cells in the brain caudate using embryonic nerve cells from a fetal pig or human fetus. Data is too preliminary to make any conclusions. Stephan Schwartz <[log in to unmask]>