Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study
Treatment of advanced Parkinson's disease by posterior GPi pallidotomy: 1-year results of a pilot study
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DOI：
10.1002/ana.410400305
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发表时间：
1996-09-01
影响因子：
11.2
通讯作者：
Delong, MR
中科院分区：
文献类型：
--
作者：
Baron, MS;Vitek, JL;Delong, MR
对15例难治性帕金森病（PD）患者进行了苍白球后部内消融术（GPi苍白球切开术）对帕金森病体征和症状的影响研究。用微电极记录和刺激识别苍白球内部及其邻近的视束和内囊的感觉运动区域。然后在确定的感觉运动区域中创建放射性损伤。苍白球切开术显著改善了所有主要帕金森病运动体征（震颤、僵硬、运动不能/运动迟缓和步态功能障碍），并减少了药物诱导的运动波动和运动障碍。改善主要发生在病变对侧，但也存在于同侧。术后早期（3个月），联合帕金森病评定量表平均总评分较术前值提高了30.1%。术后平均“开/关”Schwab和England量表评分（功能独立性的测量）从48.8%增加到73.0%。平均总联合帕金森病评定量表和Schwab和England评分在术后1年内没有显示出统计学显著性下降。手术导致的发病率很低，包括神经心理学和精神病学测试缺乏显著缺陷。在术后期间，医学结局量表上的身体和社会功能以及活力指标也显示出显著改善。这项初步研究的结果表明，消融内侧苍白球的感觉运动部分是治疗晚期PD的一种非常有效的治疗方法，获益持续1年。
The effects of posterior internal pallidal ablation (GPi pallidotomy) on parkinsonian signs and symptoms were studied in 15 patients with medically intractable Parkinson's disease (PD). The sensorimotor territory of the internal portion of the globus pallidus and the adjacent optic tract and internal capsule were identified with microelectrode recording and stimulation. Radiofrequency lesions were then created in the identified sensorimotor territory. Pallidotomy significantly improved all cardinal parkinsonian motor signs (tremor, rigidity, akinesia/bradykinesia, and gait dysfunction) and reduced drug-induced motor fluctuations and dyskinesias. The improvements occurred predominately contralateral to the lesion, but were also present ipsilaterally. Early postoperative (3-month), mean total United Parkinson's Disease Rating Scale scores improved by 30.1% from preoperative values. Mean combined ''on/off' Schwab and England Scale scores, a measure of functional independence, increased from 48.8% to 73.0% postoperatively. The mean total United Parkinson's Disease Rating Scale and Schwab and England scores did not show a statistically significant decline over the 1-year postoperative period. surgery resulted in little morbidity, including a lack of significant, deficits on neuropsychological and psychiatric testing. Physical and social functioning and vitality measures on the Medical Outcome Scale also showed significant improvement over the postoperative period. The findings of this pilot study demonstrate that ablation of the sensorimotor portion of the internal pallidum is a highly effective treatment for advanced PD, with benefits sustained at 1 year.