Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-Year results of a pilot study

Mark S. Baron, Jerrold L. Vitek, Roy A.E. Bakay, Joanne Green, Yoshiki Kaneoke, Takao Hashimoto, Robert S. Turner, John L. Woodard, Steven A. Cole, William M. McDonald, Mahlon R. DeLong

Research output: Contribution to journalArticlepeer-review

471 Scopus citations

Abstract

The effects of posterior internal pallidal ablation (GPi pallidotomy) on parkinsonian signs and symptoms were studied in 15 patients with medically intractable Parkinson's disease (PD). The sensorimotor territory of the internal portion of the globus pallidus and the adjacent optic tract and internal capsule were identified with microelectrode recording and stimulation. Radiofrequency lesions were then created in the identified sensorimotor territory. Pallidotomy significantly improved all cardinal parkinsonian motor signs (tremor, rigidity, akinesia/bradykinesia, and gait dysfunction) and reduced drug-induced motor fluctuations and dyskinesias. The improvements occurred predominately contralateral to the lesion, but were also present ipsilaterally. Early postoperative (3-month), mean total United Parkinson's Disease Rating Scale scores improved by 30.1% from preoperative values. Mean combined 'on/off' Schwab and England Scale scores, a measure of functional independence, increased from 48.8% to 73.0% postoperatively. The mean total United Parkinson's Disease Rating Scale and Schwab and England scores did not show a statistically significant decline over the 1-year postoperative period. Surgery resulted in little morbidity, including a lack of significant deficits on neuropsychological and psychiatric testing. Physical and social functioning and vitality measures on the Medical Outcome Scale also showed significant improvement over the postoperative period. The findings of this pilot study demonstrate that ablation of the sensorimotor portion of the internal pallidum is a highly effective treatment for advanced PD, with benefits sustained at 1 year.

Original languageEnglish (US)
Pages (from-to)355-366
Number of pages12
JournalAnnals of Neurology
Volume40
Issue number3
DOIs
StatePublished - Sep 1996

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