Brain, Vol. 123, No. 10, 2141-2149,
October 2000
© 2000 Oxford University Press
Postural control in Parkinson's disease after unilateral posteroventral pallidotomy
1 Texas Woman's University, 2 Parkinson's Disease Center and Movement Disorders Clinic, 3 Department of Neurology and 4 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas and 5 Ohio University, Athens, Ohio, USA
Correspondence to:
Joseph Jankovic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030, USA E-mail: JosephJ{at}bcm.tmc.edu
Postural control changes were studied in 27 patients with Parkinson's disease after unilateral posteroventral pallidotomy (PVP). Patients were evaluated before PVP and at 3, 6 and 12 months post-PVP, both `off' and `on' parkinsonian medications, with selected evaluation tools representing functional performance, functional balance and posturographic components of balance. The majority of variables in the `off' state were significantly improved at 3 months post-PVP. Improvement was maintained at 6 months but had declined for some variables by the 12 month follow-up. Standing up from a chair (P = 0.009), the balance and gait sections of the Performance-Oriented Assessment (P 
0.0004), and the limits of stability (LOS) posturography variables (P < 0.0005) of the average time to reach a target, the number of targets missed and the initial excursion distance to the target (P = 0.029) retained significant improvement at the 12 month follow-up. When the patients were in the `on' state, LOS posturography variables of average time to target, average path length deviation, and the number of targets missed were the only variables significantly improved at 3 months post-PVP (P = –0.013) and this improvement was maintained at 12 months post-PVP (P = 0.012–0.041). Unilateral PVP improves axial symptoms of Parkinson's disease involved in functional performance such as gait disturbance as well as improving postural stability in the `off' state. Generally, the maximum improvement is seen at 3 months post-PVP with many variables remaining significantly improved at 12 months post-PVP. Axial dyskinesias in the `on' state are also significantly reduced with the improvement maintained at 12 months post-PVP. These findings suggest that unilateral pallidotomy is not only effective in abolishing levodopa-induced dyskinesias, but that it also improves the axial signs of Parkinson's disease.
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