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Dear fellow listservers, The following was send by one of the listmembers to explain in lay-person's terms the difference between the two surgical options; I thought to share this with you all. Regards, Chris > For those studying the two options, pallidotomy and > bilateral STN, consider the > following: > > > 1. Pallidotomy is a relatively old procedure first used > about 50 years ago. The advent of Sinemet and other > drugs that were effective on PD made pallidotomy > unecessary. When the drugs began to fail -- the known > effective surgical treatment was pallidotomy. Therefore > that is what was used. > > 2. Like everything about PD, no two people are alike. > Many pallidotomies gradually become ineffective after 4 > to 5 years --- but there are patients who have excellent > effects for a longer period. Same as with medications. > Many of the pallidotomies were done before the newer > technology was even developed or was in the research > stages. > > 3. In layman's terms ---- a pallidotomy is kind of like > fixing a defective transmission in a car by welding the > gears into a position that works the best under most > driving conditions. If the engine becomes weaker or you > come to a big hill (ie. your PD deteriorates) you can > not undo the "repair" --- it is permanent. You can no > longer change gears in that part of the drive train. > > 4. Bilateral STN --- is like buying a computer and > printer cable. The subthalamic nucleus is the > "printer" The "printer cable" is connected to the > subthalamic nucleus and the internal pulse generator > (IPG), the computer, is connected to the cable. The IPG > sends the signal to the STN telling it what to "print" > or what "not to print". If you do not like the message > sent to the printer (your STN) you change it. You send > it a new "email". > If the computer fails -- you connect a new one to > the cable (a simple outpatient procedure). > If a newer computer and program comes along you can > plug a new computer to the cable and use the newer > technology. > AND --- if in the future a completely new technology > develops that does not require this computer or printer > cable you can remove them and install the new equipment > OR use the new medical treatment because you have not > damaged the printer (the STN). > > 5. With either procedure there is a risk of > complications as there is with any surgical procedure to > the brain. The historical results show that the risk, > though real, is very very low. > > I hope this explanation puts the choice in > understandable, layman's terms. > >