The objective of this workshop was to provide recommendations on several issues involving
pallidotomy for patients with medically intractable
Parkinson disease to physicians, patients, and other health care providers. An international consortium of experts in neurology, neurosurgery, and neurophysiology who had extensive experience with
pallidotomy were invited to the workshop. Participants were sent background materials from the scientific literature for review-based participant recommendations. A proposed agenda was circulated to all participants before the workshop, and the final agenda was based on their recommendations. Topics were introduced at the workshop by members of the organizing committee, followed by extensive group discussion. A draft of a consensus statement, based on the previous day's discussion, was circulated and further modifications were made. The final statement was agreed on by all members. The conclusions of the participants were: (1)
Pallidotomy should be performed only at centers that have a team of physicians with substantial expertise and experience in the field. (2) Patients with disabling
idiopathic Parkinson disease, without
dementia, and who have exhausted medical
therapy should be considered for
pallidotomy. (3) All patients should be examined by means of standardized rating scales both preoperatively and postoperatively to ensure quality of care at each center. (4) Symptoms that respond best to
pallidotomy include
medication-induced dyskinesias, rigidity, and
tremor, while balance, gait disorders, and hypophonia are generally less responsive to surgery. Benefits of
pallidotomy appear to be long lasting. (5) Each institution's complication rate should be discussed before surgery.