Unilateral pallidotomy for advanced Parkinson's disease

Abstract

In 1992, Laitinen reported the benefits of posteroventral pallidotomy (PVP) for the treatment of advanced idiopathic Parkinson's disease when he re-visited a procedure first described by Leksell 30 years previously (Starr et al ., 1998). The resurgence of interest was driven by the failure of medical management to successfully treat the increasing number of patients with the all too familiar long-term levodopa failure syndrome, characterized by dopa-induced dyskinesias and motor oscillations. Since then, a further 20 reasonably well-designed series on 700 patients have been published in peer-reviewed journals, with similar impressive results. A recent randomized controlled trial has confirmed highly significant benefits (Vitek et al ., 1998). Critics of the procedure often cite the paper of Sutton et al . (1995) on five patients who did not show overall benefits apart from dyskinesia suppression. Two of the clinical descriptions given in this report, however, were not suggestive of idiopathic Parkinson's disease. The efficacy of unilateral PVP in selected patients with advanced idiopathic Parkinson's disease is therefore no longer a matter of debate, but despite this many questions remain over the optimal lesion size and site, the necessity of intra-operative microelectrode recording, and the long-term benefits of the procedure. Two papers in this journal begin …