Postero-ventral pallidotomy in Parkinson's disease

Abstract

Fetal graft research and renewed interest in Leksell's postero-ventral pallidotomy (PVP) stimulated reconsideration of surgical therapy for Parkinson's disease (PD), particularly with regard to improving akinetic symptoms previously thought resistant to surgical lesions. A review of our series and other published results of PVP and fetal grafts, show that PVP has beneficial effects on both akinetic and hyperkinetic symptoms that exceed the results reported for fetal graft implantation and other conventional stereotactics. Using the Unified Parkinson's Disease Rating Scale (UPDRS) for pre- and postoperative evaluation of 113 P-V pallidotomies, we found that PVP gave significant reductions in total UPDRS scores, as well as hyperkinetic and akinetic motor scores, dyskinesias, and ‘off’ periods (P≤0.01). Moreover, P-V pallidotomy's dramatic therapeutic effects on akinesia may be explained by interruption of amplified collateral inhibitory output from the pallidum to brain stem locomotor centers such as the pedunculopontine nucleus, whereas interruption of collaterals to ventral lateral thalamus by PVP may account for the elimination of hyperkinesia. The excellent results of PVP represent a significant advance in the surgical treatment of Parkinson's disease.