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Previous Volume 342:1708-1714 June 8, 2000 Number 23 Next

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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. Twenty 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 51/2 years. There was a sustained significant improvement in on-period contralateral dyskinesia but not in other on-period signs of parkinsonism.

Source Information

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., MP 11-306, Toronto, ON M5T 2S8, Canada.

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