Re: retuning

[Peter Flintermann <PCFLINTE@xxxxxxxxxxxxxxxxx>]

Marcia--on "retuning" and pallidotomy eligibility: I can quote the criteria
and exclusions for the surgery used at the Ohio Stat U. PD Center of Excellence
, where they are now doing pallids.
EXCLUSIONS
1-OVER AGE 75
2-Dementia (MMS below 24)
3-Severe "soft voice"
4-Known major systemic disease(heart failure, renal failure)
5-Increased risk of homonymous hemianopsia (???)
6-Family or lyysician opposed
PREFERRED CHARACTERISTICS OF PATIENTS
1)Unilateral disease in non-dominant hand
2-Bradykinesia & muscle stiffness,esp. in legs
3-Rigidity of(do they mean OR?)tremor more prominent than skinesia
4-Severe ON-OFF
5-Able to tolerate stable doses of meds for 2 wks. prior to,1 mo. afterwards
6-Supportive family
7-Approval by family doc to proceed
8-Unsatisfactory response and/or tolerance to conventional drug therapy--
  consisting of L-Dopa,bromocriptine,anticholinergics,MAO-B inhibitors,or
  amantadine.
In general, we have felt that Peter was "Type B" PD patient, with little tremor
some balance problems,and frequent weakness. If so, this type is said to be
less responsive to pallid.  A post from Don Berns (3-27-95) cited "a
good attitude" as a positive factor,along with others. This would seem to rule
out someone like P. who is frequently depressed, and has increasing cognitive
problems,bilateral disease,voice problems, etc. We could be wrong--and he did
once say that if eligible he would have a pallidotomy!  He is 76, which is also
a factor, apparently.  He does have the supportive family, and I'm wondering
now if we've been too hasty in ruling out this option?
Camilla Flintermann,CG for Peter,76/6+