Objective: The aim of this research is to assess unilateral pallidotomy as a surgical alternative for Parkinson’s Disease (PD), emphasizing improvements in contralateral motor symptoms and ipsilateral dyskinesia. It also explores its feasibility in developing countries with limited access to Deep Brain Stimulation (DBS) due to cost and follow-up challenges.

Background: PD includes motor symptoms like tremor, bradykinesia, and rigidity. Long-term levodopa use can lead to complications. For insufficient medication response, interventions like DBS and pallidotomy are considered, though pallidotomy’s popularity has declined due to rising DBS use.

Method: A descriptive study at Hospital Angelina Caron that involved four patients undergoing right unilateral pallidotomy from September to November 2023. Initial clinical assessments focused on dyskinesia, and post-surgery improvements were documented, showing reduced dyskinesia and enhanced control of motor symptoms like bradykinesia, rigidity and tremor.

Results: Significant improvements occurred in both contralateral and ipsilateral dyskinesia, positively impacting other motor symptoms. Previous studies confirm pallidotomy’s effectiveness in treating PD motor symptoms, likely due to internal globus pallidus (GPi) connections with motor cortical areas. Pallidotomy, offering advantages over DBS, necessitates fewer additional procedures and less regular follow-up. It improves patients’ Hoehn and Yahr stage, although not assessed here, however it is important to consider that it’s irreversible and may require revision surgery for post-procedure adjustments. Compared to DBS, pallidotomy is three times more cost-effective, making it a potentially effective and economically viable option for advanced PD patients, reducing both direct and indirect costs.

Conclusion: Pallidotomy effectively treats advanced PD motor symptoms by influencing GPi connections, outperforming DBS in cost-effectiveness and requiring fewer procedures. Despite positive implications for disease progression, it is necessary to consider pallidotomy’s irreversibility and potential for revision surgery. Its notable cost advantage makes it an economically viable option for advanced PD treatment, especially in areas with limited DBS accessibility.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pallidotomy-as-a-therapeutic-option-for-patients-with-advanced-parkinsons-disease-case-study/