Bilateral lesions restricted to the posteroventral pallidum are unlikely to provoke corticobulbar syndrome and psychic akinesia
- 1Department of Neurosurgery, University Hospital, 901 85 Umeå, Sweden; marwan.hariz@neuro.umu.se
Merello et al reported a randomised study comparing bilateral simultaneous posteroventral pallidotomy (PVP) with a combination of unilateral PVP and contralateral pallidal stimulation.1 After having included three patients in each group, the study had to be aborted because of the severe complications encountered in the patients who had had bilateral pallidotomy.
This interesting paper raises some serious concerns.
First, the three patients who had bilateral PVP had a mean age of 67 years and those who had PVP and contralateral pallidal stimulation had a mean age of 55 years. This difference in age is said to be non-significant. As there are only three patients in each group it would perhaps have been more appropriate to have given the ages of the individual patients rather than the means.
Second, at three months after surgery, the patients who had bilateral PVP showed deterioration in parts I (mood) and II (activity of daily living) of the unified Parkinson's disease rating scale (UPDRS). The subscores of gait and postural instability worsened significantly. The …
