Five-year follow-up of unilateral posteroventral pallidotomy in Parkinson's disease

• Published in: Surgical neurology Vol. 71; no. 5; pp. 551 - 558
• Main Authors: Strutt, Adriana M., PhD, Lai, Eugene C., MD, PhD, Jankovic, Joseph, MD, Atassi, Farah, MD, Soety, Elizabeth M., PhD, Levin, Harvey S., PhD, Grossman, Robert G., MD, York, Michele K., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2009; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cognition; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Cognition Disorders - physiopathology; Female; Follow-Up Studies; Functional Laterality - physiology; Globus Pallidus - anatomy & histology; Globus Pallidus - surgery; Humans; Male; Medical sciences; Memory Disorders - diagnosis; Memory Disorders - etiology; Memory Disorders - physiopathology; Mental Processes - physiology; Middle Aged; Neurology; Neuropsychological Tests; Neuropsychology; Neurosurgery; Outcome Assessment (Health Care) - methods; Pallidotomy - adverse effects; Pallidotomy - methods; Pallidotomy - statistics & numerical data; Parkinson Disease - complications; Parkinson Disease - physiopathology; Parkinson Disease - surgery; Parkinson's disease; Posteroventral pallidotomy; Postoperative Complications - diagnosis; Postoperative Complications - physiopathology; Postoperative Complications - psychology; Psychomotor Performance - physiology; Reaction Time - physiology; Retrospective Studies; Risk Assessment; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Parkinson's disease; Stroop Color Word Test; WCST; BDI; ADL; BNT; Boston Naming Test; Cognition; COWAT-FAS; HVOT; analysis of variance; DBS; ANOVA; MMSE; UPDRS; Neuropsychology; California Verbal Learning Test; SDMT; PDMDC; Unified Parkinson's Disease Rating Scale; computed tomography; GPi; Parkinson's Disease and Movement Disorders Center; Activities of daily living; globus pallidus internus; CVLT; Stroop; Hooper Visual Organization Test; BCM; deep brain stimulation; Posteroventral pallidotomy; CT; Mini Mental Status Exam; Controlled Oral Word Association Test; Wisconsin Card Sorting Test; Baylor College of Medicine; Symbol Digit Modalities Test; Beck Depression Inventory; Nervous system diseases; Surgery; Central nervous system disease; Parkinson disease; Degenerative disease; Cerebral disorder; Extrapyramidal syndrome
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2008.03.039

Abstract Background Neurocognitive outcome research of individuals with Parkinson's disease after unilateral pallidotomy is inconsistent. Although some studies reported few cognitive changes, other investigations have more consistently shown both transient and long-term cognitive decline postoperatively. Methods We report the long-term motor and neurocognitive outcome 5 years post surgery for 18 patients with Parkinson's disease (12 men and 6 woman; all right-handed) who underwent right or left unilateral posteroventral pallidotomy. Results Pallidotomy patients revealed long-term motor benefits from the surgery in their “off” state and control of dopa-induced dyskinesias in their “on” state, which is consistent with previous research. We found mild declines in oral and visuomotor information processing speed, verbal recognition memory, and mental status 5 years after surgery, which differs from previous literature regarding the long-term neurocognitive outcome after pallidotomy. Differences between the right and left pallidotomy patients for both motor and cognitive skills were not found. Conclusion Although deep brain stimulation is presently the treatment of choice, pallidotomy continues to be performed around the world. Consequently, although unilateral pallidotomy should be considered a treatment option for patients with Parkinson's disease who suffer from severe unilateral disabling motor symptoms or dyskinesias, the long-term neurocognitive outcome should also be considered in treatment decisions.