TRANSPLANTATION OF FETAL DOPAMINE NEURONS IN PARKINSONS-DISEASE - ONE-YEAR CLINICAL AND NEUROPHYSIOLOGICAL OBSERVATIONS IN 2 PATIENTS WITH PUTAMINAL IMPLANTS
TRANSPLANTATION OF FETAL DOPAMINE NEURONS IN PARKINSONS-DISEASE - ONE-YEAR CLINICAL AND NEUROPHYSIOLOGICAL OBSERVATIONS IN 2 PATIENTS WITH PUTAMINAL IMPLANTS
复制标题
DOI：
10.1002/ana.410310206
复制
发表时间：
1992-02-01
影响因子：
11.2
通讯作者：
MARSDEN, CD
中科院分区：
文献类型：
--
作者：
LINDVALL, O;WIDNER, H;MARSDEN, CD
通过立体定向手术，将来自流产人类胎儿（年龄，受孕后 6-7 周）的腹侧中脑组织单侧植入 2 名患有晚期特发性帕金森病的免疫抑制患者（我们系列中的患者 3 和 4）的壳核中。每个患者身上都移植了 4 个胎儿的组织。与我们之前的2例患者相比，移植手术有以下变化：植入器械更薄，手术结构中放置更多组织，流产和移植之间的时间更短。无术后并发症。两名患者的帕金森症状分别在移植后 6 周和 12 周开始逐渐显着改善（患者 3 最为明显），并在大约 4 至 5 个月时达到最大稳定；此后一年的随访期间，患者保持相对稳定。观察到临床改善表现为“关闭”阶段花费的时间和每日“关闭”期的次数减少；在“关闭”阶段，运动迟缓和僵硬减轻，主要但不仅限于移植物对侧；单剂量左旋多巴作用模式的延长和改变。神经生理学测量显示，双侧（但主要是移植物的对侧）简单和复杂的手臂和手部运动表现得更快。结果表明，帕金森病患者在纹状体内植入富含多巴胺的胎儿中脑组织后，运动功能可以表现出显着且持续的改善。 Sawle 及其同事撰写的随附论文描述了对这些患者进行重复正电子发射断层扫描的结果。
Ventral mesencephalic tissue from aborted human fetuses (age, 6-7 weeks' postconception) was implanted unilaterally into the putamen using stereotaxic surgery in 2 immunosuppressed patients (Patients 3 and 4 in our series) with advanced idiopathic Parkinson's disease. Tissue from 4 fetuses was grafted to each patient. Compared with our previous 2 patients, the following changes in the grafting procedure were introduced: the implantation instrument was thinner, more tissue was placed in the operated structure, and the time between abortion and grafting was shorter. There were no postoperative complications. Both patients showed a gradual and significant amelioration of parkinsonian symptoms (most marked in Patient 3) starting at 6 and 12 weeks after grafting, respectively, reaching maximum stability at approximately 4 to 5 months; patients remained relatively stable thereafter during the 1-year follow-up period. Clinical improvement was observed as a reduction of the time spent in the "off " phase and the number of daily "off" periods; a lessening of bradykinesia and rigidity during the "off " phase, mainly but not solely on the side contralateral to the graft; and a prolongation and change in the pattern of the effect of a single dose of L-dopa. Neurophysiological measurements revealed a more rapid performance of simple and complex arm and hand movements bilaterally, but primarily contralateral to the graft. The results indicate that patients with Parkinson's disease can show significant and sustained improvement of motor function after intrastriatal implantation of fetal dopamine-rich mesencephalic tissue. The accompanying paper by Sawle and colleagues describes the results of repeated positron emission tomography scans in these patients.