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Ivan, you asked: > *** Can anyone explain which symptoms are suggestive of a PWP >benefitting from a pallidotomy, as opposed to a pallidal stimulaiton? > > My dominant symptom is freezing, and painful end-of dose symptoms, >including toes curling, sometime right inside my boots or sneakers. >Resting tremor is not present with me unless I have a sudden wearing-off. Dick had a choice of pallidotomy or pallidal stim, which was and still is considered experimental. The only reason I know of to choose a pallidal stim over pallidotomy is that the former is reversible. I think it's perhaps the treatment of choice for younger patients because if something better should come along in a few years, theoretically the electrodes can be removed and the patient is back to the pre-surgery state, ready for whatever the new treatment is. Of course, the stimulators can be turned off, too, and the electrodes left in. It would depend on what the new treatment consisted of. I guess the other benefit to a pallidal stim is that it's comforting to think that, unlike in a pallidotomy, the brain is intact after the surgery. I don't think there's much possibility of a surgical "oops," but the average patient likes the idea that if there WERE an "oops," it wouldn't be permanent. <grin> Also, the stimulator can be adjusted to stimulate any combination of 4 points on the electrode, sending messages to 4 slightly different parts of the globus pallidus. There are a total of five variables that can be adjusted, as I recall. In theory, adjustments can be made after the surgery to give the patient the best result, and re-adjustments could also be made later on to try to target other symptoms. In practice, we haven't found that there are very many settings that give a good result, so the choices aren't as wide-open as it sounds. The pallidal stim targets the exact same place in the brain that the pallidotomy does, and as far as I know has the same effect. It targets primarily dyskinesia and dystonia (those end-of-dose symptoms you describe - toe curling sounds like dystonia). Dick's primary symptom pre-surgery was tremor, and while it wasn't specifically targeted, his tremor virtually disappeared. His dystonia was also much improved. What pallidal stim DOESN'T help is freezing, balance, and voice volume. As far as I know, pallidotomy gives exactly the same result. The only thing that might be worse after pallidotomy or pallidal stim is the voice. It might be that you will end up making the decision based on availability. Pallidal stim is being done very few places in the US, and is considered strictly experimental. Pallidotomy, on the other hand, is widely available, and is covered by most insurance companies, including Medicare. Hope this helps. Margie [log in to unmask]