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April 28, 1956


JAMA. 1956;160(17):1444-1447. doi:10.1001/jama.1956.02960520006002

• The complete incapacitation seen in severe cases of Parkinsonism is illustrated by five case histories. In one instance the tremor, rigidity, and deformity were such that the patient could not even sit unsupported and had been 100% helpless for 25 years.

Surgical occlusion of the anterior choroidal artery was attempted in 50 such patients, and in 30 there was alleviation of both tremor and rigidity in the contralateral extremity. In some cases the patients have not only become ambulatory and capable of self-care but have also resumed employment. Chemical destruction of a region in the globus pallidus was attempted in a second series of 50 patients. The technique includes meticulous orientation of a cannula by means of pneumoencephalography, verification of the site by injecting procaine to observe effects in the contralateral extremity, and final injection of alcohol to destroy the active focus. Good lasting results were obtained in 32 cases.

Analysis of complications and failures will improve the methods of selecting patients and lessen the risks of operation. It is demonstrated that the tremor, rigidity, and deformity can be relieved, without loss of motor power, in long-standing, far-advanced cases.