Objective: Pallidotomy represents a viable alternative for Parkinson disease(PD) symptoms treatment and has several important advantages, including a decreased need for access to specialists and clinical follow-up, improved affordability, and a lower infection risk, producing high long-term success rates and low morbidity rates.

Background: Pallidotomy is recognized as effective for treating the symptoms of Parkinson’s disease. Sometimes, radiofrequency may be enough to allow a significant improvement in the quality of life of those patients who are unable to carry out scheduled visits after implantation of the DBS system, but correct indication it is crucial.

Method: Unilateral posteroventral pallidotomy was done in eight-three patients (35 women, 48 men) and, 66 patients underwent a contralateral pallidal deep braiin stimulation (DBS). They had predominantly unilateral symptoms with dominant dyskinesia, akinesia, and rigidity. All patients were evaluated by means of Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr Staging, and Montreal Cognitive Assessment (MOCA) and quality of life in Parkinson’s Disease (PDQ39). Results of these evaluations determined the side on which electrical stimulation or pallidotomy were performed. Mean duration of PD was 13yr; range, 6-17 yr. Received pallidotomy and 4,8 years later (range 3-7 yr) later, a contralateral pallidal DBS. Mean follow-up was 3 years (range 2-4 yr) after pallidal DBS..

Results: UPDRS off motor scores were 54 +/- 2 preoperatively anda 31 +/- 6 at last follow-up (P < 0,02). Tremor, rigidity, and bradykinesia of limbs remained improved more significantly contralateral to pallidotomy than contralateral to DBS (P = 0,044 vs. P = 0,041). Dyskinesia scores improved more markedly contralateral to pallidotomy than contralateral to DBS. Four patients exhibited moderate dysarthria anda three moderate nonreversible dysphonia, after contralateral pallidal DBS.

Conclusion: After pallidotomy there was a statistically significant improvement on quality of life. Symptoms contralateral to pallidotomy improve more than symptoms contralateral to the more recent pallidal DBS, despite visits to optimize and adapt DBS parameters. Careful selection of appropriate candidates is crucial for favorable pallidotomy outcomes. DBS may not be aways the best alternative for all patients with PD

References: Blomstedt P, Hariz GM, Hariz MI. Pallidotomy versus pallidal stimulation. Parkinsonism Relat Disord. 2006 Jun;12(5):296-301. doi: 10.1016/j.parkreldis.2005.12.007
Hyam JA, Joint C, Green AL, Aziz TZ. Comparison of contralateral pallidotomy vs. pallidal stimulation after prior unilateral pallidotomy for Parkinson’s disease. Neuromodulation. 2011 Mar-Apr;14(2):117-22; discussion 122. doi: 10.1111/j.1525-1403.2010.00318.x.

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