Pallidotomy: Effective and Safe in Relieving Parkinson’s Disease Rigidity
Keywords:
Parkinson’s disease,, yskinesia, rigidity, medically refractory.Abstract
Introduction: Parkinson's Disease (PD) is a progressive neurological disorder caused by a loss of pigmented dopaminergic neurons of the substantia nigra pars compacta. The major manifestations of the disease consist of resting tremor, rigidity, bradykinesia and gait disturbances. Before the advent of Levodopa surgery was main stay of treatment of PD. Medical therapy is still the mainstay of treatment for Parkinson's diseasebut its prolonged use results in side effects like drug induced dyskinesia. In 1952 Dr. Lars Leksell introduced Pallidotomy that was successful in relieving many Parkinsonian symptoms in patients. Later on thalamotomy became widely accepted, replacing pallidotomy as the surgical treatment of choice for Parkinson's Disease. Thalamotomy had an excellent effect on the tremor, was not quite as effective at reducing rigidity rather bradykinesia was often aggravated by the procedure.
Objective: Effectiveness of Pallidotomy in rigidity in medically refractory Parkinson’s disease and its complications.
Study Design: Descriptive prospective case series.
Setting of study: Department of Neurosurgery, Lahore General Hospital, Lahore.
Duration: June 2013 to April 2016.
Materials and Methods: Patients of Parkinson’s disease with predominant component of muscular rigidity despite maximum medical therapy admitted through outdoor department. Detailed history and physical exami-nation was done. Grading of muscular rigidity was done by applying UPDRS score Rigidity part 22. Secondary Parkinsonism was ruled out with the help of CT scan and MRI brain. Surgery was performed after informed consent.
Results: Twenty patients were included in the study with no lost to follow up. There were 14 (70%) male and 6 (30%) female patients. Mean age of the patients was 47.58 ± 8.69 years. There were 11 (55%) left sided procedures and 9 (45%) right sided Pallidotomy procedures performed. Mean pre-operative rigidity using UPRDS was 24.9 ± 1.47, while post-operative score was 11.87 ± 1.53. Pallidotomy procedure in our study had no mortality but 4 (20%) patients suffered from procedure related complications one patient (5%) had transient hemiparesis, 1 (5%) suffered from wound infection, 1 (5%) having dysarthria and 1 (5%) transient diplopia.
Conclusion: Pallidotomy is effective as well as safe surgical treatment option in reducing rigidity for medically refractory Parkinsonism’s Disease.
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