NEWS: NEJM: Long-Term Follow-up of Unilateral Pallidotomy in Advanced PD

[janet paterson <janet313@xxxxxxxxxxx>]

Long-Term Follow-up of Unilateral Pallidotomy in Advanced Parkinson's Disease

Abstract

Background. Although the short-term benefits of posteroventral pallidotomy for 
patients with advanced Parkinson's disease have been well documented, little is 
known about the long-term outcome of the procedure.

Methods. We conducted a long-term follow-up study of a cohort of 40 patients 
who had undergone unilateral posteroventral medial pallidotomy between 1993 and 
1996.

20 patients were not evaluated because they had undergone a second surgical 
procedure (11 patients) or had died (2) or because they had dementia or another 
debilitating illness (4), lived too far away (1), or had been lost to follow-up 
(2).

We conducted serial postoperative assessments of parkinsonism in the remaining 
20 patients while they were taking medications ("on" period) and after 
overnight withdrawal of the drugs ("off" period).

The mean follow-up time was 52 months (range, 41 to 64).

Results. The combined off-period score for activities of daily living and motor 
function on the Unified Parkinson's Disease Rating Scale was 18.0 percent 
better at the last evaluation than at base line (95 percent confidence 
interval, 4.9 to 31.0 percent; P=0.01).

Significant improvements were also evident in the off-period scores for 
contralateral tremor (65.4 percent improvement, P=0.007), rigidity (43.2 
percent, P=0.03), and bradykinesia (18.2 percent, P=0.04) and in the on-period 
score for contralateral dyskinesia (70.6 percent, P<0.001).

Changes in medication did not contribute to the sustained improvement.

The 20 patients who could not be included in the long-term analysis had similar 
base-line characteristics but a worse response to surgery at six months.

Conclusions. In the group of patients with advanced Parkinson's disease who 
could be enrolled in our long-term follow-up study of unilateral posteroventral 
medial pallidotomy (20 patients from the original cohort of 40), significant 
early improvements in off-period contralateral signs of parkinsonism were 
sustained for up to 5 1/2 years.

There was a sustained significant improvement in on-period contralateral 
dyskinesia but not in other on-period signs of parkinsonism.



(N Engl J Med 2000;342:1708-14.)
The New England Journal of Medicine -- June 8, 2000 -- Vol. 342, No. 23
Jennifer Fine, Jan Duff, Robert Chen, William Hutchison,
Andres M. Lozano, Anthony E. Lang
>From the Divisions of Neurology, Department of Medicine
(J.F., J.D., R.C., A.E.L.) and Neurosurgery, Department of
Surgery (W.H., A.M.L.), Toronto Western Hospital, University
of Toronto, Toronto. Address reprint requests to Dr.
Lang at Toronto Western Hospital, Morton and Gloria Shulman
Movement Disorders Centre, 399 Bathurst St., MP11-306,
Toronto, ON M5T 2S8, Canada.

Copyright 2000 by the Massachusetts Medical Society. All rights reserved.



janet paterson
53 now / 41 dx / 37 onset
613 256 8340 / PO Box 171 Almonte Ontario K0A 1A0 Canada
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