Unilateral pallidotomy for Parkinson's disease: results after more than 1 year
A Schraga, M Samuela b, E Caputoa, T Scaravillia, M Troyera, C D Marsden
a, D G T Thomasa, A J Leesa, D J Brooksa b, N P Quinna
a Department of
Clinical Neurology, Institute of Neurology, Queen Square, London, UK, b MRC Cyclotron Unit, Hammersmith Hospital,
London, UK
Correspondence to: Professor NP Quinn, Department of Clinical Neurology, Institute of Neurology, Queen Square, London WC1 3BG, UK. Telephone 0044 171 837 3611; fax 0044 171 278 5616.
Received 1 February
1999 and in revised form 4 May 1999;
Accepted 13 May 1999
OBJECTIVE
To examine
follow up results of unilateral ventral medial pallidotomy in 22 patients with advanced Parkinson's disease more than 1 year after the
operation in comparison with their results (previously reported) at 3 months.
METHODSTwenty
patients who had undergone unilateral pallidotomy were assessed with
the core assessment programme for intracerebral transplantation (CAPIT)
protocol preoperatively, at 3 months postoperatively, and again after a
median postoperative follow up of 14 months. Two further patients had
only one evaluation 3 months postoperatively.
RESULTSThe reduction
of contralateral dyskinesias (median 67%) at 3 months was slightly
attenuated after 1 year to 55% (both p<0.001 compared with baseline).
A less pronounced effect on ipsilateral and axial dyskinesias decreased
from 39% to 33% (p<0.005 and p<0.01), and from 50% to 12.5%
(p<0.001 and p<0.01), respectively. However, there was no significant
change between the 3 month and the follow up assessment. The modest
improvement of the contralateral unified Parkinson's disease rating
scale (UPDRS) motor score in the "off" state remained improved
compared with preoperative levels, but less significantly (26%,
p<0.001, and 18%, p<0.01). The activities of daily living (ADL)
subscore of the UPDRS in the off state remained improved with median
changes of 23% and 22% at follow up (both p<0.005). There was no
significant improvement of "on" state or ipsilateral off state
motor scores. Median modified Hoehn and Yahr scores in off and on state
were unchanged, as was the time spent off. Speech in off had
significantly deteriorated by 1 year after the operation.
CONCLUSIONSThe
beneficial effects of unilateral pallidotomy persist for at least 12 months and, dyskinesias are most responsive to this procedure.
Keywords: Parkinson's disease; pallidotomy; treatment; adverse events
died 29 September 1998
© 1999 by Journal of Neurology, Neurosurgery, and Psychiatry
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This article has been cited by other articles:
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van de Warrenburg, B. P C, Bhatia, K. P, Quinn, N. P
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de Bie, R M A, Schuurman, P R, Bosch, D A, de Haan, R J, Schmand, B, Speelman, J D
(2001). Outcome of unilateral pallidotomy in advanced Parkinson's disease: cohort study of 32 patients. J. Neurol. Neurosurg. Psychiatry
71: 375-382
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