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Hi Camilla, We appreciate the time and energy you spend providing useful and necessary information to the list. After all it is the responsibility of all list members to make sure anything they add of a medical nature is accurate. I want to appoligize for my youthful exuberence subsituted for common sense when I have added my two cents worth on surgical procedures. I did indeed fit the description to a "t" for the perfect candidate. My resposibility left me as emotion took over when I flat -out recommended pallitdotomy. I especially want to appologize to Debby who took the time to recognize one of my babbleings. Regards, Greg Leeman 37/6 [log in to unmask] -----Original Message----- From: Camilla H.Flintermann <[log in to unmask]> To: Multiple recipients of list PARKINSN <[log in to unmask]> Date: Tuesday, February 03, 1998 11:55 AM Subject: Pallidotomy reports >Because of the many discussions of this surgery, and especially Ida's >recent report, I thought this might be of interest: > >While surfingthe web (doesn't that sound impressive!) I came across the >site for the New EnglandJournal of Medecine,and some data re: pallidotomy >in advanced PD. >This was a discussion in letters to the Ed. of an article in the Oct.9,1997 >issue of the NEJM. > One writer questioned the study's finding that pal. was effective >treatment for advanced PD, criticizing the practice of "making destructive >lesions in a degenerating brain." > >Another writer defended the study, stating that the authors carefully >pointed out that pal. is "not appropriate for all PWPs with advanced PD", >and "should be limited to those with severe levadopa-induced dyskinesias >and those disabled by the off-period symptoms". They also stated that >"patients with compromised neuropsychological function, should not undergo >(pal.) because of the substantial risk of further cognitive decline....the >role of pal. is to treat intractable drug-induced dyskinesias...adverse >effects of surgery are substantial...this surgery should not be taken >lightly." > >In replying, the study's authors (Anthony Lang,MD,Andres Lozano,MD,both of >Toronto Hospital) pointed out that while preferable not to make a brain >lesion,there are PWPs who are so disabled by off periods and dysjinesias, >and can't wait for "further advances in our understanding". They stated >that "complications for 97% were mild,and patients would in retrospect >undergo the surgery again. They emphasized the "need for caution in >selecting patients with specific types of predominant off-period >disability, since improvement in ambulatory type symptoms waned (3-6 >months)after surgery" in their study. But they claimed that improvement in >contralateral off-period parkinsonism and levadope-induced dyskinesias >remained significant during at least 2 years of follow-up. "...we are >cautiously optimistic about the benefit of this surgery in carefully >selected patients" was the bottom line. > > > > > Camilla Flintermann, CG for Peter 79/8 > Oxford, OH > [log in to unmask] > * * * * * * * * * * * * * * * * * > * Ask me about the CARE list for* > * Parkinson's caregivers ! * > * * * * * * * * * * * * * * * * * >