Stereotactic pallidotomy in the treatment of Parkinson disease - An expertopinion

The objective of this workshop was to provide recommendations on several is sues involving pallidotomy for patients with medically intractable Parkinso n disease to physicians, patients, and other health care providers. An inte rnational consortium of experts in neurology, neurosurgery, and neurophysio logy who had extensive experience with pallidotomy were invited to the work shop. Participants were sent background materials from the scientific liter ature for review-based participant recommendations. A proposed agenda was c irculated to all participants before the workshop, and the final agenda was based on their recommendations. Topics were introduced at the workshop by members of the organizing committee, followed by extensive group discussion . A draft of a consensus statement, based on the previous day's discussion, was circulated and further modifications were made. The final statement wa s agreed on by all members. The conclusions of the participants were: (1) P allidotomy should be performed only at centers that have a team of physicia ns with substantial expertise and experience in the field. (2) Patients wit h disabling idiopathic Parkinson disease, without dementia, and who have ex hausted medical therapy should be considered for pallidotomy. (3) All patie nts should be examined by means of standardized rating scales both preopera tively and postoperatively to ensure quality of care at each center. (4) Sy mptoms that respond best to pallidotomy include medication-induced dyskines ias, rigidity, and tremor, while balance, gait disorders, and hypophonia ar e generally less responsive to surgery. Benefits of pallidotomy appear to b e long lasting. (5) Each institution's complication rate should be discusse d before surgery.