BILATERAL POSTEROVENTRAL PALLIDOTOMY IN ADVANCED PARKINSONS-DISEASE IN 3 PATIENTS

In this report, we describe the effect of staged bilateral posterovent ral pallidotomy in three patients with advanced Parkinson's disease wh o were all of the young-onset type. Two patients had developed respons e fluctuations after the use of levodopa, with severe hypokinesia, pai nful dystonia, and rigidity in the ''off'' phase and violent dyskinesi as in the ''on'' phase. One patient, in a continuous hypokinetic rigid state, was totally unresponsive to dopaminergic medication. All were at Hoehn and Yahr stage 5 in the ''off'' phase before surgery, After s urgery, the hypokinetic state was reversed and dyskinesias were abolis hed in ail patients. Hoehn and Yahr stages were 3 in the ''off'' phase postoperatively. Overall functional improvement was marked and lastin g after follow-up for 7, 12, and 13 months. respectively. Complication s were visual field deficit and transient central facial paresis, both in the same patient. Bilateral posteroventral pallidotomy can amelior ate response fluctuations, hypokinesia, rigidity, and painful dystonia in advanced Parkinson's disease.