Pallidotomy for Parkinson's Disease
In Parkinson's disease, a part of the brain called the globus pallidus is overactive. This causes a decrease in the activity of a different part of the brain that controls movement.
In a pallidotomy, the surgeon destroys a tiny part of the globus pallidus by creating a scar. This reduces the brain activity in that area, which may help relieve movement symptoms such as tremor and stiffness (rigidity).
Before surgery, detailed brain scans using magnetic resonance imaging (MRI) are done to identify the precise location for treatment.
You will be awake during the surgery. But the scalp area where surgical tools are inserted is numbed with a local anesthetic. The surgeon inserts a hollow probe through a small hole drilled in the skull to the target location. An extremely cold substance, liquid nitrogen, is circulated inside the probe. The cold probe destroys the targeted brain tissue. The probe is then removed, and the wound is closed.
Surgery on one side of the brain affects the opposite side of the body. If you have tremor in your right hand, for instance, the left side of your brain will be treated. The procedure can be repeated on the other side of the brain if needed.
What To Expect
The surgery usually requires a 2-day hospital stay. Most people recover completely within about 6 weeks.
Why It Is Done
Pallidotomy may be an option when a person with advanced Parkinson's disease has:
- Severe motor fluctuations, such as dyskinesias and on-off responses, as a result of long-term levodopa treatment.
- Severe or disabling tremor, stiffness (rigidity), or slow movement (bradykinesia) that medicine can't control.
Pallidotomy probably is not a good choice for treatment when a person has not responded to levodopa. Some studies suggest that people with parkinsonian symptoms who don't improve with levodopa therapy do not gain much benefit from pallidotomy.
How Well It Works
Pallidotomy may reduce tremor, muscle rigidity, slow movement, and other motor symptoms. Balance and speech may be improved.footnote 1 It isn't known how long the effects of pallidotomy can be expected to last. Benefits may fade over time in some people.
This type of brain surgery has less risk today than in the past. That's because technology allows the surgeon to identify with great precision the area of the brain that will be treated. Serious permanent complications are not common, although less serious side effects are.
Complications can include a stroke caused by bleeding in the brain. Many people who have a stroke recover fully and benefit from the surgery. Pallidotomy has caused problems with thought and memory (cognitive impairment) in some people.
Other risks include:
- Clarke CE, Moore AP (2007). Parkinson's disease, search date November 2006. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Current as of: December 13, 2021
Author: Healthwise Staff
Anne C. Poinier MD - Internal Medicine
Adam Husney MD - Family Medicine
Martin J. Gabica MD - Family Medicine
Kathleen Romito MD - Family Medicine
G. Frederick Wooten MD - Neurology
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