Randomized trial of pallidotomy versus medical therapy for Parkinson's disease.
Thirty-six patients with Parkinson's disease (PD) were randomized to either medical therapy (N = 18) or unilateral GPi pallidotomy (N = 18). The primary outcome variable was the change in total Unified Parkinson's Disease Rating Scale (UPDRS) score at 6 months. Secondary outcome variables included subscores and individual parkinsonian symptoms as determined from the UPDRS. At the six month follow-up, patients receiving pallidotomy had a statistically significant reduction (32% decrease) in the total UPDRS score compared to those randomized to medical therapy (5% increase). Following surgery, patients' showed improvement in all the cardinal motor signs of PD including tremor, rigidity, bradykinesia, gait and balance. Drug-induced dyskinesias were also markedly improved. Although the greatest improvement occurred on the side contralateral to the lesion, significant ipsilateral improvement was also observed for bradykinesia, rigidity and drug-induced dyskinesias. A total of twenty patients have been followed for 2 years to assess the effect of time on clinical outcome. These patients have shown sustained improvement in the total UPDRS (p < 0.0001), "off" motor (p < 0.0001) and complications of therapy subscores (p < 0.0001). Sustained improvement was also seen for tremor, rigidity, bradykinesia, percent on time and drug-induced dyskinesias.
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Related Subject Headings
- Tremor
- Treatment Outcome
- Severity of Illness Index
- Parkinson Disease
- Neurosurgical Procedures
- Neurology & Neurosurgery
- Muscle Rigidity
- Middle Aged
- Male
- Magnetic Resonance Imaging
Citation
Published In
DOI
ISSN
Publication Date
Volume
Issue
Start / End Page
Location
Related Subject Headings
- Tremor
- Treatment Outcome
- Severity of Illness Index
- Parkinson Disease
- Neurosurgical Procedures
- Neurology & Neurosurgery
- Muscle Rigidity
- Middle Aged
- Male
- Magnetic Resonance Imaging