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^^^^^^GREETINGS FROM^^^^^^^^^^ Ivan Suzman 47/10 [log in to unmask] Portland, Maine land of lighthouses 36 deg. F frost on the grape leaves ********************************************************** Margie.... Thank you for your detailed comments. They help, and I hope they'll help others. I didn't realize that BOTH ops tend to quell the same symptoms. Wouldn't be easier if one was for tremor, the other for freezing-up spells.......(sigh) Anyway, thanks for the important clarification you have provided IVAN On Wed, 24 Sep 1997 11:22:41 -0400 Margie Swindler <[log in to unmask]> writes: >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] >