Bilateral subthalamotomy in Parkinson's disease: initial and long-term response
Bilateral subthalamotomy in Parkinson's disease: initial and long-term response
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DOI：
10.1093/brain/awh397
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发表时间：
2005-03-01
期刊：
影响因子：
14.5
通讯作者：
Obeso, JA
中科院分区：
文献类型：
--
作者：
Alvarez, L;Macias, R;Obeso, JA
我们对18例晚期帕金森病患者进行了双侧丘脑底核切开术的开放性初步研究。在7名患者中，第一次丘脑底核切开术比第二次早12-24个月（“分期手术”）。随后，第二组11名患者在同一天接受双侧丘脑底核切开术（“同时手术”）。根据CAPIT（脑内移植核心评估计划）方案，一组定时运动测试和神经心理学测试对患者进行评估。在手术前和双侧丘脑底核切开术后1个月和6个月以及此后每年至少3年的“关闭”和“打开”药物状态下进行评价。与基线相比，双侧丘脑底核切开术在最后一次评估时诱导了“关闭”（49.5%）和“开启”（35.5%）的统一帕金森病评定量表（UNIPES）运动评分的显著（P < 0.001）降低。在术前和术后2年，对“关闭”和“打开”药物状态下的录像带运动检查进行盲法评级，也显示了显著的改善。帕金森病的主要特征及日常生活活动能力（ADL）评分均明显改善（P < 0.01）。与基线相比，左旋多巴诱导的运动障碍减少了50%（P < 0.01），平均每日左旋多巴剂量在末次评估时减少了47%（P < 0.0001）。13例患者在术中或术后即刻发生运动障碍，但通常为轻度且持续时间较短。3例患者出现严重的全身性舞蹈病，在接下来的3-6个月内逐渐消退。3名患者发生了严重和持续的术后构音障碍。在两个，这正好与患者表现出大的双边病变也患有严重的运动障碍。没有患者表现出永久性认知障碍。运动益处持续3-6年的随访。这项研究表明，双侧丘脑底核切开术可能会导致晚期帕金森病的显着和持久的改善，但临床结果是可变的。这种变异性可能在很大程度上取决于病变的精确位置和体积。必须进一步改进外科手术。
We conducted an open label pilot study of the effect of bilateral subthalamotomy in 18 patients with advanced Parkinson's disease. In seven patients, the first subthalamotomy pre-dated the second by 12-24 months ('staged surgery'). Subsequently, a second group of 11 patients received bilateral subthalamotomy on the same day ('simultaneous surgery'). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a battery of timed motor tests and neuropsychological tests. Evaluations were performed in the 'off' and 'on' drug states before surgery and at 1 and 6 months and every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.001) reduction in the 'off' (49.5%) and 'on' (35.5%) Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at the last assessment. A blind rating of videotape motor exams in the 'off' and 'on' medication states preoperatively and at 2 years postoperatively also revealed a significant improvement. All of the cardinal features of Parkinson's disease as well as activities of daily living (ADL) scores significantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50% (P < 0.01), and the mean daily levodopa dose was reduced by 47% at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred intraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized chorea that gradually resolved within the next 3-6 months. Three patients experienced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dyskinesias. No patient exhibited permanent cognitive impairment. The motor benefit has persisted for a follow-up of 3-6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanced Parkinson's disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Further refinement of the surgical procedure is mandatory.