Neuropsychological outcome after unilateral pallidotomy for the treatment of Parkinson's disease
Gayle M Rettiga, Michele K Yorka, Eugene C Laib, Joseph Jankovicb, Joachim K Kraussa, Robert G Grossmana, Harvey S Levina
a Department of
Neurosurgery, Baylor College of Medicine and The Methodist Hospital,
6560 Fannin, Suite 944, Houston, Texas 77030, USA, b Department of Neurology
Correspondence to: Dr Michele K York myork{at}bcm.tmc.edu
Received 21 December
1999 and in revised form 21 March 2000;
Accepted 14 April
2000
OBJECTIVE
To assess
the long term cognitive outcome of unilateral posteroventral
pallidotomy (PVP) and the overall efficacy of the surgery.
METHODSForty two (29 left and 13 right PVP) patients with Parkinson's disease underwent
neurological and neuropsychological testing before PVP and at 3 and 12 months after PVP. The neuropsychological testing battery emphasised
measures of verbal learning and memory, visuospatial abilities, speed
of information processing, executive functioning, and affective functioning.
RESULTSAll patients
demonstrated motor improvements after surgery during their off state,
and 86% of patients also showed improvements in motor functioning in
their on state. Repeated measures ANOVA showed significant improvements
in confrontational naming, visuospatial organisation, and affective
functioning 3 months and 12 months after surgery, with inconsistent
improvements in executive functioning 12 months post-PVP. Patients
demonstrated a transient impairment in verbal memory, with verbal
learning performance returning to baseline 12 months post-PVP after a
significant decline 3 months after PVP. When three patients with
lesions extending outside of the PVP were excluded from the analysis, a
decline in verbal fluency performance after PVP was not found to be
significant. Differences due to side of lesion placement were not found
on any of the cognitive measures.
CONCLUSIONSIn the
largest long term follow up study reported to date, the cognitive
changes found up to a year after PVP are minimal compared with the
robust improvements in motor function. The findings highlight the need
to investigate the relation between the specific fibre tracts affected
by the lesions and cognitive outcome.
Keywords: Parkinson's disease; posteroventral pallidotomy; neuropsychology; cognition
© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
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