NEUROPSYCHOLOGICAL, NEUROLOGICAL AND FUNCTIONAL OUTCOME FOLLOWING PALLIDOTOMY FOR PARKINSONS-DISEASE - A CONSECUTIVE SERIES OF 8 SIMULTANEOUS BILATERAL AND 12 UNILATERAL PROCEDURES

Intellectual, psychological and functional outcomes were evaluated in a consecutive series of 20 Parkinsonian patients who had unilateral (U PVP) or simultaneous bilateral posteroventral pallidotomy (BPVP) using Image Fusion(TM) and Stereoplan(TM) (Radionics Inc., Boston, Mass., U SA) with stimulation for lesion localization. Comprehensive baseline a nd 3-month postoperative neuropsychological and neurological assessmen t protocols were administered together with questionnaire measures of functional disability, quality of life and psychological symptomatolog y. Changes in patients' clinical presentation and scores on psychometr ic tests, questionnaires and observational rating scales were then exa mined. We observed no new neuropsychiatric sequelae directly related t o pallidotomy. Cognitive sequelae were restricted to selective reducti ons in categorical verbal fluency following UPVP (P < 0.001) and BPVP (P < 0.01) and a reduction in phonemic verbal fluency following BPVP ( P < 0.01); these changes were not reported subjectively. A fall in dia dochokinetic rates (P < 0.01) and some subjective reports of a worseni ng in pre-existing dysarthria, hypophonia mid hypersalivation/drooling following BPVP also suggested changes in speech motor apparatus; howe ver these changes did not have significant functional consequences. Th ere was one case of more generalized cognitive impairment following BP VP. We also observed significant symptomatic improvement on neurologic al rating scales; following UPVP, Total Unified Parkinson's Disease Ra ting Scale (UPDRS) scores improved by 27% (P < 0.01) and following BPV P the improvement was 53% (P < 0.05). Patients' perceptions of reduced postoperative functional disability and improvements in 'quality of l ife' also achieved statistical significance on a number of both physic al and psychosocial questionnaire subscales.