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Researchers Take a Longer Look at Surgical Procedure for Parkinson's

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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 America.

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 1996.

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.

However, Gerald Silverberg, MD, a professor of neurosurgery at Stanford University in Palo Alto, Calif., points out that newer procedures are rapidly taking the place of pallidotomy. "This study is mainly of historical interest, as therapy for advanced Parkinson's has moved away from pallidotomy." He explains that a newer technique is coming into favor, called deep brain stimulation, where a part of the brain is stimulated by a kind of pacemaker -- like people have for their hearts -- that is implanted in the brain.

"This appears to be a safer and more effective treatment for advanced Parkinson's, and most movement disorder clinics are using this procedure now, rather than pallidotomy," says Silverberg, who was not involved in the study.

The authors concur that the newer techniques may be safer for some patients, or even can be combined with pallidotomy in specific cases. But for selected patients with Parkinson's that does not respond to medication, the authors maintain "pallidotomy is nevertheless a useful treatment."

To read more, visit WebMD's Diseases and Conditions Parkinson's page.

Vital Information:

  • Parkinson's disease is a neurological disorder characterized by tremors, problems with balance when walking and standing, rigidity, and a reduced amount of movement.
  • Pallidotomy is a surgical procedure that can dramatically improve the symptoms of Parkinson's disease at first, but some of these effects wear off over time.
  • A newer treatment for the disease is deep brain stimulation, which may be safer and more effective than pallidotomy.
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