With the introduction of levodopa in the treatment of Parkinson’s Disease (PD) the need for surgical intervention declined rapidly.
Long term follow up of patients on medical treatment showed increased dosing over period of time with dose related side effects in the form of dyskinesias and hallucinations.
Surgical intervention were thus again explored in patients having sub optimal benefits with medical management.
Dr. Lauri Laitinen in 1985 was the first to demonstrate the benefits of pallidotomy by performing the procedure as described by Dr. Lars Leksell.
In 1992 he published his series of 38 patients treated with pallidotomy which showed 80-90% patients showed long lasting symptom relief.
Drawing showing the relationship of the pallidal target to the internal capsule and optic tract.
Indications for Pallidotomy in Parkinson’s disease
- Levodopa induced dyskinesias
- Motor fluctuations in the form of severe wearing off or On-Off fluctuations.
- Off period Dystonia
- Gait disturbance during Off periods