[Bilateral pallidotomy for the treatment of advanced Parkinson disease]

Many patients with Parkinson's disease (PD) suffer from severe bilateral appendicular off (bradykinesia, rigidity, tremor) and on (dyskinesia, dystonia) symptoms. After unilateral pallidotomy several of these patients still suffer from severe bradykinesia, rigidity, or dyskinesia of the ipsilateral side. In addition such symptoms as walking difficulty, freezing, trunk, neck, or facial dyskinesia are not significantly alleviated after unilateral pallidotomy. These patients seem to be good candidates for bilateral staged pallidotomy. The aim of this study is to evaluate the motor symptoms after staged bilateral pallidotomy in advanced PD patients. 34 patients were studied. The patients were assessed using UPDRS version 3, Hoehn and Yahr scale, Schwab and England scale before and up to 24 months after surgery in off and on state. In off drug state, the total motor score of the UPDRS compared to preoperative off drug state was improved by 61% at 24 months of follow-up. All cardinal features of PD improved significantly in postoperative drug off state compared to drug off state before bilateral pallidotomy--parkinsonian tremor (items 20-21) by 62%, rigidity (item 22 UPDRS) by 81% and bradykinesia (items 23-26) by 67%. Also gait including falling, freezing, walking (items 13-14-15 UPDRS) and gait and postural stability (items 29-30 UPDRS) showed good improvement by 69% with bilateral pallidotomy in off drug phases. There was minimal improvement in motor score of UPDRS in on state. Duration of dyskinesia and severity of dyskinesia (items 32-33 UPDRS) showed dramatic improvement after bilateral pallidotomy. Bilateral pallidotomy affords impressive elimination of all appendicular and truncal dyskinesias, dystonias, and generally improved all symptoms in off state.