Authors' objectives:

This report aims to assess the effectiveness and appropriateness of stereotactic pallidotomy for the treatment of Parkinson's disease.

Authors' results and conclusions: Issues regarding techniques for electrophysiological localization of the precise target in the posteroventral globus pallidus and optimal patient selection remain unresolved. No studies in the published literature comparing outcomes after pallidotomy with and without mapping were identified. The neurosurgical community is divided on the benefits and risks of microelectrode mapping. Prevailing data, derived exclusively from case series, suggest that pallidotomy ameliorates drug-induced dyskinesias and significantly improves PD symptoms without mortality or significant morbidity. However, all the studies have methodological limitations. No large scale randomized controlled trials have been conducted to substantiate the efficacy of pallidotomy. The reported benefits of pallidotomy are weakened by the overall limited nature of the available evidence. Alternative surgical treatments for PD are being developed. High-frequency stimulation of the globus pallidus is under current clinical investigation and may be an alternative to pallidotomy. The data are preliminary, and conflicting results have been reported. At this time, no conclusions can be reached as to the benefits, risks and potential of this technology.

Authors' recommendations: A systematic review of pallidotomy was published by the Health Care Technology Assessment (HCTA) Unit of the Alberta Heritage Foundation for Medical Research in Canada in January of 1997. This report concluded that while several trials reported relief of symptoms of PD and strong anecdotal evidence by patients of improved quality of life, the quality of the evidence was fair to poor with few data on long term outcomes. The HCTA Unit recommended that the procedure be performed in specialized centers that have both neurological and neurosurgical expertise. They also stressed the need for improved systematic data collection and comparative studies of pallidotomy versus alternative therapies. The MDRC review includes more recent data from 1997. The prevailing evidence is insufficient to conclude that the benefits of pallidotomy outweigh the risks for the patients represented in the literature. This review confirms that the conclusions and recommendations from the Alberta review are durable.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/Publications.asp

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: U. S. Department of Veterans Affairs