- For PD
- Very seldom used as DBS is very successful
- Pallidotomy is a “salvage” procedure because:
- The reduction in motor complications is not as significant as that achieved with DBS
- The alleviation of motor symptoms gain is asymmetrical, due to the inability to perform bilateral lesioning without significant side effects.
- GPi stimulation is relatively comparable with pallidotomy and may be used bilaterally with less side effects than bilateral pallidotomy.
- Only patients with treatment-resistant idiopathic Parkinson’s disease that have clearly responded to dopamine replacement therapy in the past should be considered candidates for pallidotomy
- Advanced PD patients with DBS implants are not providing benefit because of the natural history of the patient’s cognitive decline
- Instead of repeating having battery changes better to do pallidotomy
- Infection of the implanted device may become more frequent with worsening mobility and ability to care for themselves.
- Behavioural side effects of STN stimulation has resulted in a large number of patients with preexisting cognitive or behavioural symptoms or with end-stage PD not being considered for surgical intervention.
- Hemidystonia is another indication for pallidotomy
- Early data suggest might be beneficial but need more data
- Parkinson’s plus syndromes,
- Specific risks include injury to the optic tract or the internal capsule which are both near the optimal lesion location.
- No implant hardware
- No stimulator adjustment
- Apparently durable (~ 5-10 years) treatment
- If incorrectly placed pallidotomy
- May result in little or no benefit
- May cause adverse effects:
- Visual field defects.
- Features of PD which respond best are drug induced dyskinesias, painful dystonias, marked ON/OFF fluctuations, severe bradykinesia, and rigidity.
- Symptoms that may improve but do so less reliably are tremor, speech dysfunction and gait disturbance.
Pallidotomy
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