PMID: 9782254: Pallidotomy with the gamma knife: a positive experience.

[janet paterson <janet313@xxxxxxxxxxx>]

Pallidotomy with the gamma knife: a positive experience.

51 patients with medically refractory Parkinson's disease underwent 
stereotactic posteromedial pallidotomy between August 1993 and February 1997 
for treatment of bradykinesia, rigidity, and L-DOPA-induced dyskinesias.

In 29 patients, the pallidotomies were performed with the Leksell Gamma Knife 
and in 22 they were performed with the standard radiofrequency (RF) method.

Clinical assessment as well as blinded ratings of Unified Parkinson's Disease 
Rating Scale (UPDRS) scores were carried out pre- and postoperatively.

Mean follow-up time is 20.6 months (range 6-48) and all except 4 patients have 
been followed more than one year.

85 percent of patients with dyskinesias were relieved of symptoms, regardless 
of whether the pallidotomies were performed with the Gamma Knife or 
radiofrequency methods.

About 2/3 of the patients in both Gamma Knife and radiofrequency groups showed 
improvements in bradykinesia and rigidity, although when considered as a group 
neither the Gamma Knife nor the radiofrequency group showed statistically 
significant improvements in UPDRS scores.

One patient in the Gamma Knife group (3.4%) developed a homonymous hemianopsia 
9 months following treatment and 5 patients (27.7%) in the radiofrequency group 
became transiently confused postoperatively.

No other complications were seen.

Gamma Knife pallidotomy is as effective as radiofrequency pallidotomy in 
controlling certain of the symptoms of Parkinson's disease.

It may be the only practical technique available in certain patients, such as 
those who take anticoagulants, have bleeding diatheses or serious systemic 
medical illnesses.

It is a viable option for other patients as well.


Stereotact Funct Neurosurg 1998 Oct;70 Suppl 1:218-28
Young RF, Vermeulen S, Posewitz A, Shumway-Cook A
Northwest Gamma Knife Center, Northwest Hospital, Seattle, Wash., USA.
PMID: 9782254, UI: 99000787

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janet paterson
52 now / 41 dx / 37 onset
613 256 8340 po box 171 almonte ontario canada K0A 1A0
a new voice: <>
<janet313@xxxxxxxxxxx>