Long term outcome of unilateral pallidotomy: follow up of 15 patients for 3 years
- Neurodegenerative Disorders Centre, M 36 Purdy Pavilion, Vancouver Hospital and Health Sciences Centre, 2221 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
- Dr D B Calnevisnansk{at}interchange.ubc.ca
- Received 29 September 1999
- Revised 24 February 2000
- Accepted 2 March 2000
Abstract
OBJECTIVES With the advent of new antiparkinsonian drug therapy and promising results from subthalamic and pallidal stimulation, this study evaluated the long term efficacy of unilateral pallidotomy, a technique which has gained popularity over the past decade for the management of advanced Parkinson's disease.
METHODS The 15 patients reported here are part of the original cohort of 24 patients who underwent posteroventral pallidotomy for motor fluctuations and disabling dyskinesias 3 years ago as part of a prospective study. Evaluation scales included the unified Parkinson's disease rating scale, the Goetz dyskinesia scale, and the Purdue pegboard test.
RESULTS When compared with the prepallidotomy scores, the reduction in the limb dyskinesias and off state tremor scores persisted on the side contralateral to pallidotomy at the end of 3 years (dyskinesias were reduced by 64% (p<0.01) and tremor by 63% (p<0.05). Other measures tended to deteriorate. The dosage of antiparkinsonian medications did not change significantly from 3 months prepallidotomy to 3 years postpallidotomy.
CONCLUSIONS Although unilateral pallidotomy is useful in controlling the contralateral dyskinesias and tremor 3 years after surgery, all other early benefits disappear and activities of daily living continue to worsen.
