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| Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study |
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| Author(s): Baron MS, Vitek JL, Bakay RAE, Green J, Kaneoke Y, Hashimoto T, Turner RS, Woodard JL, Cole SA, McDonald WM, Delong MR |
| Source: ANNALS OF NEUROLOGY Volume: 40 Issue: 3 Pages: 355-366 Published: SEP 1996 |
| Times Cited: 420 References: 35 |
| Abstract: The effects of posterior internal pallidal ablation (GPi pallidotomy) on parkinsonian signs and symptoms were studied in 15 patients with medically intractable Parkinson's disease (PD). The sensorimotor territory of the internal portion of the globus pallidus and the adjacent optic tract and internal capsule were identified with microelectrode recording and stimulation. Radiofrequency lesions were then created in the identified sensorimotor territory. Pallidotomy significantly improved all cardinal parkinsonian motor signs (tremor, rigidity, akinesia/bradykinesia, and gait dysfunction) and reduced drug-induced motor fluctuations and dyskinesias. The improvements occurred predominately contralateral to the lesion, but were also present ipsilaterally. Early postoperative (3-month), mean total United Parkinson's Disease Rating Scale scores improved by 30.1% from preoperative values. Mean combined ''on/off' Schwab and England Scale scores, a measure of functional independence, increased from 48.8% to 73.0% postoperatively. The mean total United Parkinson's Disease Rating Scale and Schwab and England scores did not show a statistically significant decline over the 1-year postoperative period. surgery resulted in little morbidity, including a lack of significant, deficits on neuropsychological and psychiatric testing. Physical and social functioning and vitality measures on the Medical Outcome Scale also showed significant improvement over the postoperative period. The findings of this pilot study demonstrate that ablation of the sensorimotor portion of the internal pallidum is a highly effective treatment for advanced PD, with benefits sustained at 1 year. |
| Document Type: Article |
| Language: English |
| Reprint Address: Baron, MS (reprint author), EMORY UNIV, DEPT NEUROL, SCH MED, 6000 WMRB, ATLANTA, GA 30322 USA |
Addresses:
1. EMORY UNIV, DEPT NEUROSURG, SCH MED, ATLANTA, GA 30322 USA
2. EMORY UNIV, DEPT PSYCHIAT, SCH MED, ATLANTA, GA 30322 USA |
| Publisher: LITTLE BROWN CO, 34 BEACON STREET, BOSTON, MA 02108-1493 |
| Subject Category: Clinical Neurology; Neurosciences |
| IDS Number: VG795 |
| ISSN: 0364-5134 |
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