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On Thu, 30 Jul 1998, Joanna Porvin wrote: > 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? yes it is formal name for my pallidotomy --on left side > 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. I was not tested before so loss of word skills cannot be confirmed I know there is some loss. Dr said there are a few others with same changes pallidotomy is not a permanent fix Anne Rutherford 64 dx1980 > 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] > > >