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Pallidotomy for Parkinson’s disease
By Vidushi Seneviratne
Parkinson's disease is seen more often in men and women over fifty. "Anyone can contract it and the cause is unknown," says Dr. Colvin Samarasinghe, Senior Consultant Neurosurgeon, describing it as crippling to both the patient and everyone else involved.

The various aspects of the disease and the medical options available were discussed at a recent press conference held at Ward 9 of the National Hospital, Colombo.

"To carry out any action, it is essential to have Dopamine in the brain. It is the lack or degeneration of Dopamine -(a chemical substance that regulates movement) releasing cells in deep areas of the brain, that causes the body to lose control even when doing basic activities," said Dr. Samarasinghe. "The most common symptoms of the disease are tremors, stiffness or unsteadiness usually in one arm, difficulties in walking, softening of the voice, reduced facial expression and reduced blinking. The patient usually walks with a stoop, takes small steps and does not swing his or her arms. The tremor seems more like a pin rolling movement of the thumb and fingers," he added.

Treatment for Parkinson's disease can be initiated with medication that is relatively inexpensive (such as Benzexhol or Artane). But after a time, these drugs might turn out to be ineffective and even have side effects. Newer drugs such as Levodopa that can be converted to Dopamine in the body are also available, but are more expensive and with time, might have unfavourable side effects too.

Pallidotomy, a surgical procedure now being done at the National Hospital, Colombo is considered an extremely effective and cost worthy solution for Parkinson's. Here, a stereotactic frame is first fixed onto the patient's head under local anaesthesia. Following this is the accurate locating of the area of destruction within the brain (the pallidal target) using Magnetic Resonance Imaging (MRI). Since CT scans alone are inadequate for the localisation of the target, ideally a combination of CT and MRI images are fed into a computer workstation, for extreme accuracy before the surgery begins. Once the exact spot is located, that particular part of the globe's pallidotomy is destroyed.

"We have to ensure accuracy upto 1mm. If not, there could be severe results such as paralysis, partial loss of vision and speech. But if carried out correctly, the results are extremely satisfactory to the patients," he said.

Beginning in 1998, Dr. Samarasinghe says that about twenty patients have had pallidotomy at the Neurosurgical Unit 1 of the National Hospital with the assistance of Dr. S. Warunashantha, Registrar in Neurosurgery and Lionel Dissananyake, senior radiographer.

"I had a tremor in my body and I used to fall quite often. I tried out various medications and treatments such as acupuncture, but nothing cured me," says Mary Kodipillai, a patient with Parkinson's disease, who described herself as someone who used to sleep a lot and have uncoordinated actions. "But after I had the surgery, I feel completely alright and even do all the work at home. I feel like a different person," she said.

K.B. Dassanayake, another patient whose condition has improved tremendously after surgery said that earlier he was not able to even do basic tasks like wearing the sarong or shirt on his own, but "now I'm doing great".

Done only at the National Hospital, the surgery takes about two to three hours and any general practitioner could refer a patient to Ward 9 of the hospital to be treated for this condition. Dr. Samarasinghe, however points out that though pallidotomy is a successful method of countering Parkinson's disease, it is not the most suitable. "In more developed countries, pallidotomy is not done now as it involves cell destruction which is an irreversible process. Instead they use a form of therapy named Deep Brain Stimulation (DBS) which is much more effective from a medical point of view. But with our limited resources and pallidotomy being a relatively less costly method, it can change the lives of these patients in an extremely positive way," he said.

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