Outcome of unilateral pallidotomy in advanced Parkinson’s disease: cohort study of 32 patients

Objectives—In a randomised trial to study the eYcacy of unilateral pallidotomy in patients with advanced Parkinson’s disease, patients having pallidotomy within 1 month after randomisation were compared with patients having pallidotomy 6 months after the primary outcome assessment. Of the 37 patients enrolled 32 had a unilateral pallidotomy. The follow up study of these patients is presented to report (1) clinical outcome; (2) adverse eVects; (3) cognitive and behavioural eVects; (4) relation between lesion location and outcome; and (5) preoperative patient characteristics predictive for good outcome. Methods—Outcome measures were the motor section of the unified Parkinson’s disease rating scale (UPDRS), levodopa induced dyskinesias, disability, quality of life, and a comprehensive neuropsychological assessment. Multivariate logistic regression was used to identify preoperative patient characteristics independently associated with good outcome. Results—OV phase assessment showed a reduction in parkinsonism from 49 to 36.5 points on the UPDRS 6 months after surgery. Improvements were also demonstrated for activities of daily living and quality of life. In the on phase dyskinesias were reduced. All eVects lasted up to 12 months after surgery. Three patients had major permanent adverse eVects. Besides worsening of verbal fluency after left sided surgery, systematic cognitive deterioration was not detected. Patients taking less than 1000 levodopa equivalent units (LEU)/day were more likely to improve. Conclusions—The positive eVects of unilateral pallidotomy are stable up to 1 year after surgery. Patients taking less than 1000 LEU per day were most likely to improve. (J Neurol Neurosurg Psychiatry 2001;71:375–382)