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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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
Issue number5
StatePublished - May 1 2003


Cite this

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