NEUROLOGY 1998;51:207-215
© 1998 American Academy of Neurology
Neuropsychological consequences of posteroventral pallidotomy for the treatment of Parkinson's disease
Lisa L. Trépanier, MA,
Jean A. Saint-Cyr, PhD,
Andres M. Lozano, MD, PhD and
Anthony E. Lang, MD
From the Department of Psychology (L. L. Trépanier and Dr. Saint-Cyr) and the Playfair Neuroscience Unit (L. L. Trépanier, and Drs. Saint-Cyr, Lozano, and Lang), The Toronto Hospital; the Department of Surgery, Division of Neurosurgery (Dr. Lozano), University of Toronto and The Toronto Hospital; the Department of Medicine, Division of Neurology(Dr. Lang), University of Toronto and Morton and Gloria Shulman Movement Disorder Centre at The Toronto Hospital; the Department of Psychology, York University (L.L. Trépanier and Dr. Saint-Cyr); and the Departments of Anatomy & Cell Biology and Psychology (Dr. Saint-Cyr), University of Toronto.
Address correspondence and reprint requests to Lisa L. Trépanier, Toronto Hospital-Western Division, 399 Bathurst Street, Department of Psychology, Edith Cavell Wing, 2-003 Toronto, Ontario M5T 2S8, Canada.
Objective: Neuropsychological changes were assessed in patients who had idiopathic PD after unilateral posteroventral pallidotomy.
Methods: Posteroventral stereotactic pallidotomies were performed on 42 PD patients(24 right and 18 left hemisphere). All patients were evaluated in the "on state" before the procedure (n = 42) and at intervals of 3 (n = 26), 6 (n = 27), and 12+ (n = 24) months after surgery.
Results: Modest improvement in sustained attention and decline in working memory was observed by 6 months after surgery. Left hemisphere lesions led to a loss of verbal learning (-2.2 SD) and verbal fluency (-1.6 SD) in 60% of patients at their first evaluation at 3 or 6 months. No patients returned to baseline on the verbal fluency task and most (71%) did not recover verbal-learning ability by 12 months after surgery. Right hemisphere lesions led to a loss of visuospatial constructional abilities (-3.5 SD), which fully resolved by 12 months for all but one patient. Evidence of further decline of frontal-executive functioning was noted within other tasks but not on a"direct" test (i.e., Conditional Associative Learning). Lastly, behavioral changes of a "frontal nature" were reported in 25% to 30% of patients. These cognitive and emotional costs increased dependence in these domains and negatively affected some patients' relations with caregivers and restricted their ability to function properly at work or in social settings. Caregivers, particularly, and patients who were aware of their resulting changes had difficulty adjusting after surgery.
Conclusions: Although patients and caregivers were generally pleased with the clinical neurologic outcome of the procedure, the neurologic benefits of unilateral pallidotomy must be weighed against modest cognitive and behavioral risks.
Received June 2, 1997. Accepted in final form March 25, 1998.
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