Dr. Fazzini reported that unilateral pallidotomies significantly decrease contralateral dyskinesia, tremor, rigidity, and bradykinesia and that these improvements are still evident 4 years later. Following pallidotomy, patients still have PD and may continue to deteriorate in terms of balance and cognitive function, two symptoms of PD which the pallidotomy does not help. Dr. Fazzini pointed out that bilateral pallidotomy offered more improvement than unilateral pallidotomy but at a cost of increased salivation, speech difficulty and swallowing impairment. Dr. Vitek emphasized the importance of placing the lesion in the proper location. The greatest probability of placing the lesion in the correct place is achieved when intracellular recording is used during the procedure.
Lesions placed in the wrong part of the medial globus produce inferior results.
Best results are obtained when the lesions are placed into the ventral and posterior-most section of the medial globus pallidus. Dr. Lang agreed with the two other speakers on the beneficial effects of pallidotomy. He mentioned that his center has just begun placing deep brain stimulators into the globus pallidus with mixed results. There seems to be less side effects using this procedure, especially in patients receiving bilateral interventions, but the beneficial effects may not be as great since the stimulator emits a signal which jams the abnormal inhibitory circuit less than a lesion directly placed into the circuit. This procedure is promising, but more work is needed.