Brain, Vol 121, Issue 4 659-675, Copyright © 1998 by Oxford University Press
R Scott, R Gregory, N Hines, C Carroll, N Hyman, V Papanasstasiou, C Leather, J Rowe, P Silburn and T Aziz
Intellectual, psychological and functional outcomes were evaluated in a
consecutive series of 20 Parkinsonian patients who had unilateral (UPVP) or
simultaneous bilateral posteroventral pallidotomy (BPVP) using Image Fusion
and Stereoplan (Radionics Inc., Boston, Mass., USA) with stimulation for
lesion localization. Comprehensive baseline and 3- month postoperative
neuropsychological and neurological assessment protocols were administered
together with questionnaire measures of functional disability, quality of
life and psychological symptomatology. Changes in patients' clinical
presentation and scores on psychometric tests, questionnaires and
observational rating scales were then examined. We observed no new
neuropsychiatric sequelae directly related to pallidotomy. Cognitive
sequelae were restricted to selective reductions in categorical verbal
fluency following UPVP (P < 0.001) and BPVP (P < 0.01) and a
reduction in phonemic verbal fluency following BPVP (P < 0.01); these
changes were not reported subjectively. A fall in diadochokinetic rates (P
< 0.01) and some subjective reports of a worsening in pre-existing
dysarthria, hypophonia and hypersalivation/drooling following BPVP also
suggested changes in speech motor apparatus; however, these changes did not
have significant functional consequences. There was one case of more
generalized cognitive impairment following BPVP. We also observed
significant symptomatic improvement on neurological rating scales;
following UPVP, Total Unified Parkinson's Disease Rating Scale (UPDRS)
scores improved by 27% (P < 0.01) and following BPVP the improvement was
53% (P < 0.05). Patients' perceptions of reduced postoperative
functional disability and improvements in 'quality of life' also achieved
statistical significance on a number of both physical and psychosocial
questionnaire subscales.
ARTICLES
Neuropsychological, neurological and functional outcome following pallidotomy for Parkinson's disease. A consecutive series of eight simultaneous bilateral and twelve unilateral procedures
Department of Neurological Surgery, Radcliffe Infirmary, Oxford, UK.
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