Pallidotomy in the treatment of complicated Parkinson's disease: clinical results at two years and analysis of prognostic factors
Linazasoro G, Gorospe A, Rodríguez MC, Guridi J, Ramos E, Mozo A, Obeso JA.
Centro de Neurología y Neurocirugía funcional, Clínica Quirón, San Sebastián
There is a renewed interest in pallidotomy as a treatment for complicated Parkinson's disease (PD).
To present the clinical results as well as the analysis of prognostic factors obtained in 28 patients with PD and motor complications submitted to pallidotomy and followed by one year (n = 28) and 2 years (n = 12).
The total motor score (Unified Parkinson's Disease Rating Scale [UPDRS]) in the off state improved by 33 and 23% at one and two years, respectively (p < 0.01). All the cardinal signs of the disease were significantly improved (p < 0.01): tremor (92%), rigidity (67%), bradykinesia (46%) and axial symptoms (21%). A slight tendency to worsening in axial symptoms was observed. Dyskinesias disappeared in all but one patient. The Schawb & England Scale in off was improved by 21%. No improvement in the non-operated side was observed. The subgroup of patients with an improvement of less than 30% in the UPDRS was older than the one with larger clinical benefit. The observed tendency to worsening in the total motor score was related mainly to the progression of the symptoms in the non-operated side. Complications were mild and transient.
Pallidotomy is a relatively safe and effective therapeutic option for complicated PD patients. An adequate selection of patients is necessary, since efficacy is partial and limited to one hemibody.
CITATION Neurologia. 1999 Feb;14(2):53-61