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Predictors of neuropsychological outcome in patients following microelectrode-guided pallidotomy for Parkinson's disease.

AbstractOBJECT:
The authors studied neuropsychological performance following microelectrode-guided posteroventral pallidotomy in patients with Parkinson's disease (PD) and evaluated correlations with presurgical and surgical factors.
METHODS:
Neuropsychological changes 3 months (43 patients) and 12 months (27 patients) after microelectrode-guided pallidotomy for PD are reported in a series of 44 consecutive patients with the disease, who improved neurologically, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS) in both the "off' (p<0.001) and best "on" (p<0.001) states. Findings of the vocabulary subtest of the Wechsler Adult Intelligence Scale-Revised (p<0.01), Letter Fluency (p<0.001), Verbal Fluency for semantic categories (p<0.001), and the Wisconsin Card Sorting Test (p<0.01) showed a significant decline in neuropsychological performance in patients 3 months after undergoing left-sided pallidotomy. Impairment in the language domain (semantic fluency) persisted at the 12-month follow-up examination (p<0.01). Visual memory improved after right-sided pallidotomies (p<0.01 after 3 months), with a nonsignificant trend toward persistent improvement 1 year postsurgery (p<0.02 after 12 months). Preoperative semantic fluency was influenced by patient age (p<0.001) and by the width of the third ventricle (p<0.05), as measured by magnetic resonance imaging. A regression model revealed that semantic fluency 3 months postoperatively was significantly affected by the baseline score (p<0.001), side of surgery (p<0.001), handedness (p<0.01), and patient age (p<0.05). However, postoperative lesion volume, lesion location, number of tracks, number of lesions, distance from anatomical landmarks, or UPDRS score did not significantly contribute to neuropsychological outcome.
CONCLUSIONS:
Neuropsychological changes in a cohort of patients with PD who underwent pallidotomy and experienced excellent clinical benefits and minimum postoperative complications, emphasize the importance of neuropsychological examinations and further investigation of predictive factors.
AuthorsA A Obwegeser, R J Uitti, J A Lucas, R J Witte, M F Turk, R E Wharen Jr
JournalJournal of neurosurgery (J Neurosurg) Vol. 93 Issue 3 Pg. 410-20 (Sep 2000) ISSN: 0022-3085 [Print] UNITED STATES
PMID10969938 (Publication Type: Journal Article)
Topics
  • Aged
  • Cognition
  • Cohort Studies
  • Female
  • Globus Pallidus (surgery)
  • Humans
  • Intelligence Tests
  • Language
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Parkinson Disease (psychology, surgery)
  • Predictive Value of Tests
  • Treatment Outcome

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