Staged bilateral pallidotomy for treatment of Parkinson disease

Object. Several investigators have described the motor benefits derived fro m performing unilateral stereotactic pallidotomy for the treatment of Parki nson disease (PD), but little is known about the efficacy and complication rates of bilateral procedures. The goal of this study was to assess both th ese factors in 12 patients. Methods. Eleven patients with medically intractable PD underwent staged bil ateral pallidotomy and one patient underwent a simultaneous bilateral proce dure. Unilateral pallidotomy resulted in an improvement in the patients' Un ified Parkinson Disease Rating Scale (UPDRS) total scores and motor subscor es, Hoehn and Yahr stages, and Schwab and England Activities of Daily Livin g scores. There were no complications. The second procedures were performed 5 to 25 months after the first, and nearly complete 3-month follow-up data are available for eight of these patients. Staged bilateral pallidotomy di d result in further improvements in some symptoms, but the patients proved to be less responsive to levodopa. In contrast to outcomes of the initial u nilateral pallidotomy, there were significant complications. One patient su ffered an acute stroke, two patients suffered delayed infarctions of the in ternal capsule, four patients had mild-to-moderate worsening of speech and increased drooling, and one patient complained of worsening memory. Conclusions. Bilateral pallidotomy results in modest benefits but is associ ated with an increased risk of complications.