USEFULNESS OF PALLIDOTOMY IN ADVANCED PARKINSONS-DISEASE

Objective-The combined effect of posteroventral pallidotomy and optima l treatment was assessed in 22 patients with levodopa sensitive Parkin son's disease. Methods-Timed motor tests, video recordings, and comput er assisted optoelectronic movement analysis were used for serial hour ly assessments performed preoperatively and four and 12 months after o peration. Tests were made while patients were on optimal medical thera py. Results-There were no serious adverse events of surgery. Two of th e 22 patients could not complete all the tests after operation. The pr oportion of dyskinesia periods decreased in the 20 patients and there was a proportional increase in normal or fairly normal occasions. ''Of f'' periods were not significantly affected. In 12 of 13 patients with limb dyskinesia this symptom was completely abolished in the contrala teral limbs There was also some degree of improvement axially and ipsi laterally. Tremor was moderately improved contralaterally. Bradykinesi a remained unchanged. Results at 12 months follow up were similar to t hose at four months. Conclusion-Pallidotomy produced a pronounced posi tive effect on dyskinesia and a moderate effect on tremor. Bradykinesi a was not affected. Posteroventral pallidotomy may be useful in patien ts with Parkinson's disease who have severe motor fluctuations and may allow an increase in levodopa dose to alleviate bradykinesia in ''off '' states.