MOTOR, COGNITIVE, AND BEHAVIORAL PERFORMANCE FOLLOWING UNILATERAL VENTROPOSTERIOR PALLIDOTOMY FOR PARKINSON-DISEASE

Objective: To evaluate the effects of ventroposterior pallidotomy on m otor disability and on behavior and cognition in patients with medical ly intractable idiopathic Parkinson disease. Design: Detailed motor te sting both while receiving and discontinuing levodopa medication, post urography, and neurocognitive and behavioral assessments were performe d before and 3 to 6 months after unilateral ventroposterior pallidotom y. Setting: University-based movement disorder program. Patients: Thir ty-two patients without dementia with medically refractory idiopathic Parkinson disease were studied. Main Outcome Measures: Motor function and disability were measured using the Unified Parkinson's Disease Rat ing Scale, Hoehn and Yahr stage, and the Schwab and England Activities of Daily Living Scale. Dynamic balance was measured by sway (amplitud e and velocity) using the Chattecx Balance System. Detailed cognitive and behavioral assessments were also performed both before and after s urgery. Results: Eighty-three percent of patients experienced improvem ent of their total Unified Parkinson's Disease Rating Scale score at 3 to 6 months after surgery. Significant improvements were also seen in the contralateral Unified Parkinson's Disease Rating Scale motor subs core (78%) as well as in the contralateral Unified Parkinson's Disease Rating Scale total score both during the on and off peroid (78% and 7 9%, respectively). The Hoehn and Yahr stage, Schwab and England Activi ties of Daily living Scale score, and dynamic balance when standing on foam also improved following unilateral pallidotomy in many patients. Cognitive performance remained relatively unchanged following surgery with the exception of category fluency, which exhibited a modest decl ine (P<.04). A significant improvement in depression was found on the Beck Depression Inventory.Conclusions: Ventroposterior pallidotomy sig nificantly improves motor performance and daily, level of function in Parkinson disease. Cognition and behavior are not adversely affected i n patients without dementia, and a cognitive screening battery is prop osed.