GK Pallidotomy for Dystonia

For the obvious reasons of industry driven nature of neurosurgical practices, lesioning is now becoming an “orphan drug”. Many companies have stopped manufacturing lesioning apparatus after companies promoting stimulation surgeries buy them. There is no promotion of lesioning in academic meetings, no keynote or industry sponsored lectures, and hardly any teacher. We are short of enough literature on pallidotomy for dystonia than pallidotomy for PD, as pallidotomy for dystonia was introduced much later than pallidotomy for PD, till then DBS had already become a preferred treatment option for PD. Robert E Gross has raised this issue in a systemic literature review commenting that, “bilateral Gpi DBS is neither more effective nor safer than bilateral pallidotomy for primary dystonia, and both are equally ineffective for secondary dystonia”. In countries with limited resources, pallidotomy for dystonia should be preferred to DBS because of obvious financial implications. As there is no definition for remission and cure of dystonia, it would not be an exaggeration to say that DBS may control but not cure dystonia while lesioning may cure it. Pallidotomy shows a high response rate, low complication profile, and chances of life long cure in experienced hands. Apart from it, we find it non-justified to put enormous financial burden on a poor young patient who would need lifelong care for frequent battery changes and visits for stimulation settings.
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Manjul Tripathi
Associate Professor
Dept. of Neurosurgery, PGIMER, Chandigarh
Gamma Knife Radiosurgery
Functional Neurosurgery, Oxford University, United Kingdom
Post Graduate Institute of Medical Education and Research (PGIMER)
Chandigarh, India
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