Cognitive sequelae of unilateral posteroventral pallidotomy

V. M. Soukup, F. Ingram, M. C. Schiess, J. G. Bonnen, H. J. Nauta and J. R. Calverley
Department of Neurology, University of Texas Medical Branch, Galveston 77555-0539, USA.

OBJECTIVE: To examine the cognitive sequelae of unilateral posteroventral pallidotomy. DESIGN: Single-group pretest and posttest methodologic assessment with baseline evaluation performed 1 to 2 days prior to surgery and follow-up conducted 3 months after pallidotomy. SETTING: Movement disorder clinic at a university medical center. PATIENTS: Fourteen patients (age range, 43-82 years) with Parkinson disease (average disease duration, 7.4 years). INTERVENTION: Unilateral posteroventral pallidotomy procedures were performed on the right (n=8) and left (n=6) side of the brain. MAIN OUTCOME MEASURES: The protocol consisted of a range of neuropsychological instruments sensitive to subcortical dysfunction, including measures of bi-manual coordination, simple-complex reaction time, visual attention, naming, verbal fluency, learning, recognition memory, and problem solving. RESULTS: No significant deterioration in specific cognitive abilities was observed as a function of the procedure. Patients showed a significant improvement in motor coordination speed for both contralateral and ipsilateral upper extremities. CONCLUSIONS: Stereotactic unilateral posteroventral pallidotomy is associated with minimal risk of adverse neuropsychological effects or cognitive decline. Additional research is warranted, with an increased sample size and extended follow-up, to assess any potential lateralized effects of the procedure.

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