Neuropsychological Outcome following Pallidotomy and Thalamotomy for Parkinson’s Disease

Abstract

Cognitive and emotional outcomes were assessed after unilateral posteroventral pallidotomy (PVP) and ventral intermediate nucleus thalamotomy (Vim-Th) in patients suffering from idiopathic Parkinson’s disease (PD). PVP was performed on 12 PD patients (8 men and 4 women, mean age 56.4 years, 6 left lesions and 6 right lesions) and Vim-Th was performed on 13 PD patients (5 men and 8 women, mean age 63.2 years, 6 left lesions and 7 right lesions). In both the PVP group and the Vim-Th group, the Hoehn and Yahr staging scores (p < 0.01) and the Unified Parkinson’s Disease Rating Scale activities of daily living and motor scores (p < 0.001) improved significantly. No significant changes in cognitive function were observed 4 weeks after unilateral PVP or Vim-Th. PVP produced a significant decline in Hasegawa’s Dementia Scale-Revised scores in immediate postoperative assessments (p < 0.05), which resolved 4 weeks after surgery. While the Minnesota Multiphasic Personality Inventory depression and social introversion scores improved significantly in the Vim-Th group (p < 0.01 and p < 0.05, respectively), the hypochondriasis and hypomania scores improved significantly in the PVP group (p < 0.01 and p < 0.05, respectively). We conclude that PVP and Vim-Th influence postoperative emotional status rather than postoperative cognitive status.

Effects of pallidotomy and bilateral subthalamic stimulation on cognitive function in Parkinson disease

“…Cognitive effects of pallidotomy have been studied in a relatively extensive manner and no consistent pattern of cognitive findings following pallidotomy has been identified [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. On the other hand, few studies have analysed the adverse cognitive effects of bilateral STN-DBS and no relevant neuropsychological deterioration has been described [21][22][23][24][25][26].…”

“…There are numerous studies regarding neuropsychological consequences of unilateral pallidotomy [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], s Abstract Unilateral pallidotomy and bilateral subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease (PD) have demonstrated a positive effect on motor functions. However, further studies are needed of the unintended cognitive effects accompanying these new surgical procedures.…”

Psychiatric aspects of Parkinson?s disease

“…In particular, subcutaneous apomorphine rescue injections have been shown to provide rapid improvement of such psychiatric symptoms in addition to alleviation of motor symptoms [56]. Neurosurgical interventions for PD can also lead to improvement of mental state [38,41,90] but deterioration of mental state has also been reported. Bilateral posteroventral pallidotomy has been associated with impairments on neuropsychological tests [84], and with depression and apathy [65], and a minority of patients undergoing subthalamic nucleus stimulation develop psychiatric and behavioural complications, such as hypomania or mania, increased sexuality, depression, anxiety, suicide, or affective blunting despite successful improvement of motor symptoms [18,36,48,80].…”

Psychomotor and executive functioning after unilateral posteroventral pallidotomy in patients with Parkinson's disease

“…Some of them showed no evidence of cognitive impairment [29][30][31][32][33]. Other reports revealed declines, most consistently involving verbal fluency, both phonemic and semantic, particularly after left-sided lesions in right-handed patients [34][35][36][37][38][39][40][41].…”