Unilateral pallidotomy highly effective in select patients with
Parkinson's disease
WESTPORT, Oct 04, 1999 (Reuters Health) - The "dramatic" benefits of
unilateral pallidotomy in patients with Parkinson's disease persist for
at least 1 year, according to British investigators who report their
experience with the procedure in the October issue of the Journal of
Neurology, Neurosurgery and Psychiatry.
"[I]n view of the potential risks associated with this invasive
procedure, careful selection of patients is necessary," Dr. A. Schrag,
of the Institute of Neurology in London, UK, and multicenter colleagues
explain in the journal.
The team determined functional outcomes in 22 Parkinson's patients who
underwent unilateral ventral medial pallidotomy at 3 months and outcomes
in 20 of the 22 patients at 14 months.
The "...dramatic improvement in on state contralateral dyskinesias, and
the more modest improvement in off state parkinsonism..." observed at 3
months "...persisted for more than 1 year," Dr. Schrag and colleagues
report.
Specifically, contralateral dyskinesias were reduced by 67% at 3 months
and 55% at 1 year compared with baseline. Unilateral pallidotomy also
caused reductions in ipsilateral and axial dyskinesias from 39% to 33%
and from 50% to 12.5%, respectively, between the two time points of 3
months and 1 year.
Improvements in unified Parkinson's disease rating scores during the
"off" state were less significant after 1 year than after 3 months, but
still significant, according to the authors.
The amount of time spent with dyskinesias, the severity of dyskinesias
and pain associated with dyskinesias also improved postoperatively at
both time points.
Performance of the procedure was associated with "appreciable" morbidity
and mortality, Dr. Schrag and colleagues say, with two
procedure-associated deaths and four major complications. Of the four
patients, three had a persistent defect resulting from the complication,
but considered themselves "improved overall" despite this effect.
Further research is necessary to determine if the use of microelectrode
recording may improve the safety of pallidotomy, the authors note.
With these risks in mind, the researchers say that the efficacy of
unilateral pallidotomy in patients with Parkinson's disease is strongly
dependent on patient selection. "Young patients who have severe,
asymmetric, on state dyskinesias are most likely to benefit from
pallidotomy....[while] patients with predominantly axial features such
as impairment of gait, balance and speech are less likely to improve,"
they say.
J Neurol Neurosurg Psychiatry 1999;67:511-517.
Copyright © 1996, 1997, 1998, 1999 Reuters Ltd.
--
Judith Richards, London, Ontario, Canada
[log in to unmask]
^^^^
\ /
\ | / Today’s Research
\\ | // ...Tomorrow’s Cure
\ | /
\|/
`````
