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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 ! * * * * * * * * * * * * * * * * * *