Fwd: Re: pallidotomy

[Robert Fink <rafink@xxxxxxxxxxxxx>]

Barbara and Listmembers:

Posted below is a respond by Patrick Kelly, M. D., Professor and
Chairman of Neurosurgery at New York University School of Medicine
concerning the present status of pallidotomy in PD.  It is re-posted
with Dr. Kelly's permission.  I have suggested to Dr. Kelly that he sign
on to this List and he said that he would do so.  Dr. Kelly is one of
the leading academic neurosurgeons in the world and will make an
excellent addition to this List.

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Pallidotomy

I admit that I was skeptical about this procedure, knowing that most who
practiced stereotactic pallidotomy in the early 60's began doing
thalamotomy
where the results for tremor were better and the localization by
neurophysiologic methods more precise. Of course, L-Dopa put them all
out of
business.

I've done thalamotomies for tremor for over 20 years in patients with
medically
refractory tremor or in patients unable to take L-Dopa. I heard several
reports
on the retreaded pallidotomy procedure and was skeptical that it could
help
bradykinesia-the real disabling symptom of Parkinson's disease.

I was skeptical until I started doing the pallidotomy procedures myself.
I
agree now that it's a good operation and the results on bradykinesia,
foot
cramping, drug induced dyskinesia and rigidity have been impressive. How
long
will they persist? I really don't know. This is being studied. Will the
procedure "cure" Parkinson's disease? Get real. It defies the
imagination to
think that creating yet another lesion in a sick brain is going to cure
the
disease or stop it's progression. Slow its progression? This needs to be
studied in a prospective randomized trail with matched sets of
patients-di
fficult to do.

In my opinion, however, pallidotomy is a good operation if carefully
performed.

PJ Kelly



\--------------------------------------------------------------\
\   Patrick Kelly, MD   \  Internet: kelly@xxxxxxxxxxxxxxxxxx  \
\   NYU Medical Center  \  Phone: (212)-263-8002               \
\   New York, N Y       \                                      \
\                       \                                      \
\--------------------------------------------------------------\

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Best wishes to all,

Bob

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Robert A. Fink, M. D., F.A.C.S.   Phone: 510-849-2555
Neurological Surgery              FAX:  510-849-2557
2500 Milvia Street  Suite 222
Berkeley, California 94704-2636
USA

E-Mail:  rafink@xxxxxxxxxxxxx
CompuServe:  72303,3442
America Online:  BobFink          "Ex Tristitia Virtus"

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