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Pallidotomy
A pallidotomy is a surgical procedure that was developed in the 1950s for the treatment of the symptoms of Parkinson's disease. As medications were developed, this surgical procedure was neglected until recently, when interest was rekindled by several investigators throughout the world.
The procedure consists of producing a small lesion in a very specific region of the brain called the globus pallidus, which interrupts nerve signal transmission to other brain regions. The beneficial consequences are to reduce the rigidity and improve movements that are symptoms of Parkinson's disease, and on some occasions reduce tremor. Thus, this procedure is designed to treat symptoms, but not cure Parkinson's disease. Most patients will need to continue medications, though the medications may be reduced or be more effective for longer periods of time. The patient's personal physician is critical to this program, since that physician will be involved in adjustment of medications and will oversee the patient's routine health care needs.
There is a good deal of information on pallidotomy, both in the medical literature and in the lay press. Pallidotomy is performed using stereotactic procedures, which enable the surgeon to identify the region of the brain to be lesioned using a CT or MRI scan. At the University of Michigan, this anatomic localization of the specific region is enhanced by a physiologic recording of the neurons in this region. This enables the team to identify the specific neuronal regions that are abnormal, based on neuronal recordings, as opposed to relying solely on anatomic parameters.
As part of the program, patients will participate in a study of long term efficacy and complications. Patients will be evaluated by a University of Michigan Neurologist and Neurosurgeon to determine if a pallidotomy procedure is appropriate for treatment of their Parkinson's disease. If the patient appears to be a suitable candidate, further preoperative testing is obtained and surgery is scheduled. Follow-up occurs at six months after surgery and includes functional testing, as well as MR imaging. If the patient had a successful response and symptoms on the opposite side of the body warrant a second pallidotomy procedure, the patient will then be scheduled for this second procedure.
Certain conditions may preclude patients from benefiting from pallidotomy. For example, if the patient also has cognition and memory problems, if there are severe joint deformities from being at the end stage of the disease or if there are underlying medical conditions such as severe hypertension, multiple strokes or brain tumors, pallidotomy may not be possible. Age itself is not an exclusion, but patients over age 75 may have increased risk of complications (stroke/death) or may be less likely to respond to the procedure.
