Randomized trial of pallidotomy versus medical therapy for Parkinson's disease

Jerrold L. Vitek, Roy A E Bakay, Alan Freeman, Marian Evatt, Joanne Green, William McDonald, Michael Haber, Huiman Barnhart, Natalie Wahlay, Shirley Triche, Klaus Mewes, Vijay Chockkan, Jian Yu Zhang, Mahlon R. DeLong

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Abstract

Thirty-six patients with Parkinson's disease (PD) were randomized to either medical therapy (N = 18) or unilateral GPi pallidotomy (N = 18). The primary outcome variable was the change in total Unified Parkinson's Disease Rating Scale (UPDRS) score at 6 months. Secondary outcome variables included subscores and individual parkinsonian symptoms as determined from the UPDRS. At the six month follow-up, patients receiving pallidotomy had a statistically significant reduction (32% decrease) in the total UPDRS score compared to those randomized to medical therapy (5% increase). Following surgery, patients' showed improvement in all the cardinal motor signs of PD including tremor, rigidity, bradykinesia, gait and balance. Drug-induced dyskinesias were also markedly improved. Although the greatest improvement occurred on the side contralateral to the lesion, significant ipsilateral improvement was also observed for brady-kinesia, rigidity and drug-induced dyskinesias. A total of twenty patients have been followed for 2 years to assess the effect of time on clinical outcome. These patients have shown sustained improvement in the total UPDRS (p < 0.0001), "off" motor (p < 0.0001) and complications of therapy subscores (p < 0.0001). Sustained improvement was also seen for tremor, rigidity, bradykinesia, percent on time and drug-induced dyskinesias.

Original languageEnglish (US)
Pages (from-to)558-569
Number of pages12
JournalAnnals of Neurology
Volume53
Issue number5
DOIs
StatePublished - May 1 2003

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Vitek, J. L., Bakay, R. A. E., Freeman, A., Evatt, M., Green, J., McDonald, W., Haber, M., Barnhart, H., Wahlay, N., Triche, S., Mewes, K., Chockkan, V., Zhang, J. Y., & DeLong, M. R. (2003). Randomized trial of pallidotomy versus medical therapy for Parkinson's disease. Annals of Neurology, 53(5), 558-569. https://doi.org/10.1002/ana.10517