Despite the recent resurgence of interest in the use of pallidotomy for the
treatment of Parkinson's disease, there remains considerable debate about
the optimal lesion site. Although the current understanding of the neural m
echanisms underlying Parkinsonism would suggest that the medial pallidum is
the logical site for alleviation of symptoms, some surgeons still advocate
lesions in the lateral pallidum. We report the case of such a lesion place
ment verified pathologically, which resulted in exacerbation of akinesia po
stoperatively, This demonstrates that accurate targeting in the pallidum is
critical to avoid exacerbation of symptoms by lesioning the lateral pallid
um. (C) 1999 Harcourt Publishers Ltd.