Researchers Take a Longer Look at Surgical Procedure for Parkinson's
June 7, 2000 -- When actor Michael J. Fox announced that he had
Parkinson's disease and was leaving his critically acclaimed television series
at the end of the season, he caused a minor sensation. Because of his celebrity
status, he helped bring a little-known disorder into the eyes of mainstream
Despite progress made in research, both the cause and cure of
Parkinson's still remains elusive. Fox, who has become an activist and formed
his own foundation to fight the disorder, says he hopes that a cure will be
found within the next 10 years. But for now, symptoms can only be treated,
usually by medication, although one surgical technique has shown some long-term
success when medications don't work.
Parkinson's disease is a neurological disorder, and common
symptoms are tremors, problems with balance when walking and standing,
rigidity, and a reduced amount of movement. While various drugs can
dramatically improve symptoms, they tend to lose their effectiveness over time
in some patients.
So, for a number of individuals with advanced Parkinson's,
doctors have opted to perform a surgical procedure known as pallidotomy, which
has provided symptom relief in many cases. When a pallidotomy is performed,
small holes are punched in an area of the brain involved in motion control.
Pallidotomy is the most common surgery performed, but while the
short-term effectiveness of pallidotomy has been reported in a number of
studies, there is very little information about the long-term outcome from this
procedure. Many patients who are deciding whether to have surgery ask if the
effects of the surgery will be maintained over a long period of time, according
to Robert Worth, MD. Worth, who is a professor of neurological surgery at
Indiana University School of Medicine, was not involved in the study.
A team of Canadian researchers led by Anthony Lang, MD, a
professor of medicine at the University of Toronto, examined the long-term
outcome of 20 patients who had undergone this procedure between 1993 and
The results of the study, which appear in the current issue of
The New England Journal of Medicine, were mixed. The researchers used a variety
of questionnaires and tests to judge how well these patients were doing several
years after their initial surgery. Though many symptoms of the disease improved
after surgery, some problems did re-emerge, although in most cases to a lesser
extent than before surgery.
Worth says that this report encourages physicians to continue
to recommend this procedure, especially to certain types of patients.
Pallidotomy is not a new procedure, and in fact, was one of
several procedures that were used as early as the 1950s to treat Parkinson's.
When medications became available, many of these surgeries were abandoned in
favor of the pharmaceutical treatment, but for some patients, surgery remains
the best option for symptom relief.