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Hello all. I read this article with interest and no small amount of concern. I have two questions to throw out to the group: 1. I am unfamiliar with the term "posteroventral stereotactic." Could one of our medical folks please elaborate? Is this just the formal name for the most common type of pallidotomy? 2. I would be interested to hear from PWPs and CGs who have had *first-hand* experience with pallidotomy, specifically could you please address the "cognitive impairment and behavioral changes" you experienced/witnessed. Thanks from all of us. Joanna (CG) In a message dated 7/29/98 11:11:32 PM EST, [log in to unmask] writes: > Surgery for Parkinson's disease carries > neuropsychologic risks > > WESTPORT, Jul 29 (Reuters) - Unilateral posteroventral > pallidotomy for the treatment of Parkinson's disease is > sometimes associated with modest cognitive impairment and > behavioral changes, Canadian researchers warn in the July > issue of Neurology. > > Dr. Lisa L. Trepanier, of The Toronto Hospital-Western > Division, in Ontario, Canada, with colleagues there and > elsewhere, studied 42 patients with advanced Parkinson's > disease who had "...substantial disability because of frequent > 'off' periods or drug-induced dyskinesias." > > Twenty-four patients underwent posteroventral stereotactic > pallidotomy on the right hemisphere of the brain and 18 > patients on the left side of the brain. Before surgery and 3, 6 > and/or 12 months afterward, each patient completed a battery > of neuropsychologic tests. > > As a group, the patients showed improvements in attention > and concentration by 6 months after surgery compared with > their preoperative test scores, Dr. Trepanier's team reports. > Their working-memory capacity declined, however. > Conditional associative learning, a measure of frontal > executive function, was not affected. > > Among patients who had undergone left-sided pallidotomies, > the team found that verbal learning was impaired in 60% at the > time of the first follow-up examination, 3 or 6 months after > surgery. Verbal fluency had also declined significantly. Most > patients with impaired verbal learning showed no improvement > during the study period, and none regained their initial ability. > > In contrast, verbal learning significantly improved in 44% of > right-pallidotomy patients, the investigators determined. > Right-hemisphere pallidotomies impaired visuospatial > constructional ability, but all except one patient recovered this > ability completely within 12 months after surgery. > > In 25% to 30% of the patients, pallidotomy "...resulted in > poorer frontal executive behavioral control (eg, environmental > dependency, lack of insight, lability, depression, poor > judgment, impulsiveness, obsessive-compulsive behavior)," > the Toronto researchers report. > > "For some patients, these problems negatively affected their > relationship with caregivers, especially when they lacked > awareness of their deficits or when altered judgment and > increased emotional lability were present," the authors note. > "These difficulties also restricted proper functioning at work or > in social settings, depending on the patients' circumstances." > > Dr. Trepanier's group recommends that "...the neurologic > benefits of unilateral pallidotomy...be weighed against modest > cognitive and behavioral risks." > > Neurology 1998;51:207-215. > -- > Judith Richards, London, Ontario, Canada > [log in to unmask] >