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Pallidotomy in Parkinson´s disease

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SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

Findings by SBU Alert

This is a translation of version 1, published on June 5, 1999. The latest version of this report is not available in English.

Neurosurgery is not widely used to complement pharmacological treatment of Parkinsons disease. Pallidotomy, a procedure involving heating of malfunctioning brain tissue with an electrode, is the method which has received greatest attention during the 1990s. Several uncontrolled studies have shown that pallidotomy reduces symptoms such as hyperkinesia (involuntary movement), rigidity (stiffness), dystonia (painful muscle cramps), tremors (shakiness), and akinesia (poverty of movement), in that order.

Based on the studies reviewed, SBU Alert has found moderate* evidence to support the short-term effects of the method on patient symptoms. However, poor* evidence has been presented yet regarding the duration of these effects and their importance on the patients quality of life.

Pallidotomy should be performed only in conjunction with scientific studies until more knowledge is acquired on patient benefits and reliable data demonstrates the relationship between costs and benefits.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Assoc Prof Marwan Hariz, MD PhD, Norrland’s University Hospital in Umeå. It has been reviewed by Olof Corneliusson, MD, Sahlgrenska University Hospital.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

Referenser

  1. Baron MS, Vitek JL, Bakay RA, et al. Treatment of advanced Parkinson´s disease by posterior GPi pallidotomy: 1-year results of a pilot study. Ann Neurol 1996;40:355-366.
  2. Carrol CB, Scott R, Davies LE, Aziz T. The pallidotomy debate. Br J Neurosurg 1998;12(2):146-150.
  3. Cohn MC, Hudgins PA, Sheppard SK, Starr PA, Bakay RA. Pre- and postoperative MR evaluation of stereotactic pallidotomy. AJNR Am J Neuroradiol 1998;19:1075-80.
  4. De Bie RM, De Haan RJ, Nijssen PC, Rutgers AW, Bente GN, et al. Unilateral pallidotomy in Parkinson's disease; a randomised single blind, multicenter trial. Lancet, 1999;354:1665-69.
  5. Dogali M, Fazzini E, Kolodny E, Eidelberg D, Sterio D, Devinski O, Beric A. Stereotactic ventral pallidotomy for Parkinson´s disease. Neurology 1995;45:753-761.
  6. Fazzini E, Dogali M, Sterio D, Eidelberg D, Beric A. Stereotactic pallidotomy for Parkinson´s disease: A long-term follow-up of unilateral pallidotomy. Neurology 1997;48:1273-77.
  7. Hariz MI, DeSalles AA. The side-effects and complications of Posteroventral pallidotomy. Acta Neurochir suppl 1997;68:42-48.
  8. Hariz MI. Controversies in pallidal surgery. Acta Neurochir Suppl 1997;68:1-10.
  9. Johansson F, Malm J, Nordh E, Hariz MT. Usefulness of pallidotomy in advanced Parkinson´s disease. J Neurol Neurosurg Psychiatry, 1997;62:125-132.
  10. Kishore A, Turnbull IM, Snow BJ, de la Fuente-Fernandez R, Schulzer M, Mak E, Yardley S, Calne DB. Efficacy, stability and predictors of outcome of pallidotomy for Parkinson´s disease. Six-month follow-up with additional 1-year observations. Brain 1997;120:729-737.
  11. Krack P, Pollak P, Limousin P, Hoffmann D, Benazzouz A, Le Bas JF, Koudsie A, Benabid AL. Opposite motor effects of pallidal stimulation in Parkinson´s disease. Ann Neurol 1998; 43:180-192.
  12. Kumar R, Lozano AM. Montgomery E, Lang AE. Pallidotomy and deep brain stimulation of the pallidum and sub-thalamic nucleus in advanced Parkinson´s disease. Movement Disorders 1998;13: 73-82.
  13. Laitinen LV, Bergenheim AT, Hariz MI. Leksell´s posteroventral pallidotomy in the treatment of Parkinson´s disease. J Neurosurg, 1992;76:53-61.
  14. Laitinen LV, Hariz MI, Movement Disorders, in Youmans JR (ed): Neuro-logical Surgery, ed 4. Philadelphia: WB Saunders, 1996, Vol 5, pp 3575-3609.
  15. Laitinen LV. Pallidotomy for Parkinson´s disease. Neurosurgery Clinics of North America 1995;6:105-112.
  16. Lang AE, Lozano AM, Montgomery E, Duff J, Tasker R, Hutchinson W. Posteroventral medial pallidotomy in advanced Parkinson´s disease. The New England Journal of Medicine 1997;337: 1036-42.
  17. Linazasoro G, Guridi J, Gorospe A, Ramos E, Mozo A, Obeso JA. Post-eroventral pallidotomy in Parkinson´s disease. Clinical results in 27 patients. (abstract) Movement Disorders 1996;11, suppl 1:240.
  18. Lozano AM, Kumar R, Gross RE, et al. Globus pallidus internus pallidotomy for generalized dystonia. Movement Disorders 1997;12:865-870.
  19. Lozano AM, Lang AE, Galvez-Jimenez N, Miyasaki J, Duff J, Hutchison WD, Dostrovsky JO. Effect of GPi pallidotomy on motor function in Parkinson´s disease. Lancet 1995;346:1383-87.
  20. Samuel M, Caputo E, Brooks DJ, et al. A study of medial pallidotomy for Parkinson´s disease: clinical outcome, MRI location and complications. Brain 1998;121:59-75.
  21. Scott R, Gregory R, Hines N, Carroll C, Hyman N, Papanasstasiou V, Leather C, Rowe J, Silburn P, Aziz T. Neuropsychological, neurological and functional outcome following pallidotomy for Parkinson´s disease. A consecutive series of eight simultaneous bilateral and twelve unilateral procedures. Brain 1998;121:659-675.
  22. Shannon KM, Penn RD, Kroin JS, et al. Stereotactic pallidotomy for the treatment of Parkinson´s disease. Efficacy and adverse effects at 6 months in 26 patients. Neurology 1998;50:434-438.
  23. Tronnier VM, Fogel W, Kronenbuerger M, Steinvorth S. Pallidal stimulation: an alternative to pallidotomy? J Neurosurg 1997;87:700-705.
  24. Vitek JL, Bakay RA, Hashimoto T, Kaneoke Y, Mewes K, Yu Zhang J, Rye D, Starr P, Baron M, Turner R, DeLong MR. Microelectrode-guided pallidotomy: technical approach and its application in medically intractable Parkinson´s disease. J Neurosurg 1998;88:1027-43.
  25. Development and Evaluation Committee. Report no 51. March 1996. Roberts.R&D Directorate, NHS Executive South and West.
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