Outcome of unilateral and bilateral pallidotomy for Parkinson's disease: Patient assessment
Outcome of unilateral and bilateral pallidotomy for Parkinson's disease: Patient assessment
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DOI：
10.1097/00006123-200002000-00017
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发表时间：
2000-02-01
期刊：
影响因子：
4.8
通讯作者：
Hammerstad, J
中科院分区：
文献类型：
--
作者：
Favre, J;Burchiel, KJ;Hammerstad, J
目的：苍白球切开术作为一种安全有效的治疗帕金森病的方法，最近重新被接受。本研究的目的是获得患者对接受该手术后结果的看法。特别注意的是集中在潜在的并发症和各自的优势和风险的单方面与双边pallidotomy.METHODS：五十六例患者进行了研究，在2年期间，44完成了评估，平均随访7个月。其中22例行单侧苍白球切开术，17例行双侧同时苍白球切开术。5例接受分期双侧苍白球切开术的患者被排除在统计分析之外，因为认为患者数量太少，无法进行分析。结果：根据视觉模拟量表评分，单侧苍白球毁损术明显改善运动障碍（P < 0.05），但无其他症状。同时双侧苍白球毁损术改善了缓慢、僵硬、震颤和运动障碍（P < 0.05），但恶化了语言功能（P < 0.05）。根据患者最常选择的多项选择题的答案，单侧苍白球切开术改善了夜间睡眠、肌肉疼痛、冻结、整体“开”、整体“关”以及“关”的持续时间，但它恶化了声音和发音的音量，增加了流口水，降低了注意力。双侧苍白球切开术改善了夜间睡眠、肌肉疼痛、冻结、总体“开”、总体“关”、“关”期的持续时间和服用的药物量，但它增加了流涎，恶化了声音、发音和书写的音量。分别有36%和41%的单侧和同时双侧苍白球切开术患者出现主观视觉障碍。在全球范围内，64%接受单侧苍白球切开术的患者和76%接受双侧苍白球切开术的患者将手术结果评为“良好”或“极好”。年龄小于70岁是一个积极的预后因素的全球结果（P <0.05），作为严重的术前运动障碍（P <0.05）。结论：这项研究证实，从病人的角度来看，单侧和同时双侧苍白球切开术可以减少帕金森病的所有关键症状（即，运动不能、震颤和僵硬）和左旋多巴治疗的副作用（即，运动障碍）。术前严重的运动障碍和年轻是成功预后的积极预后因素。同时双侧苍白球切开术比单侧苍白球切开术在震颤、僵硬和运动障碍方面更有效，但术后言语恶化的风险更高。
OBJECTIVE: Pallidotomy has recently regained acceptance as a safe and effective treatment for Parkinson's disease symptoms. The goal of this study was to obtain the patients' perspective on their results after undergoing this procedure. Special attention was focused on the potential complications and the respective advantages and risks of unilateral versus bilateral pallidotomy.METHODS: Fifty-six patients were studied during a 2-year period; 44 completed the evaluation, with a median follow-up of 7 months. Of these patients, 22 underwent unilateral pallidotomy, and 17 had bilateral simultaneous pallidotomy. Five patients who underwent staged bilateral pallidotomy were excluded from the statistical analysis, because the number of patients was considered too small for analysis. The procedures were performed with magnetic resonance imaging determination of the target, combined with physiological confirmation, including microelectrode recording.RESULTS: According to Visual Analog Scale scores, unilateral pallidotomy significantly improved dyskinesias (P < 0.05) but no other symptoms. Simultaneous bilateral pallidotomy improved slowness, rigidity, tremor, and dyskinesias (P < 0.05) but worsened speech function (P < 0.05). According to the patients' most frequently chosen answers to multiple-choice questions, unilateral pallidotomy improved night sleep, muscle pain, freezing, overall "on," overall "off," and the duration of "off periods," but it worsened the volume of the voice and articulation, increased drooling, and reduced concentration. Bilateral pallidotomy improved night sleep, muscle pain, freezing, overall "on," overall "off," duration of "off periods," and the amount of medication taken, but it increased drooling and worsened the volume of the voice, articulation, and writing. Subjective visual disturbance was noted in 36 and 41% of patients who underwent unilateral and simultaneous bilateral pallidotomy, respectively. Globally, the result of the procedure was rated "good" or "excellent" by 64% of the patients who underwent unilateral pallidotomy and by 76% of the patients who underwent bilateral pallidotomy. An age less than 70 years was a positive prognostic factor for the global outcome (P < 0.05), as were severe preoperative dyskinesias (P < 0.05).CONCLUSION: This study confirms that, from a patient standpoint, unilateral and simultaneous bilateral pallidotomy can reduce all the key symptoms of Parkinson's disease (i.e., akinesia, tremor, and rigidity) and the side effects of L-dopa treatment (i.e., dyskinesias). Preoperative severe dyskinesias and younger age are positive prognostic factors for a successful outcome. Simultaneous bilateral pallidotomy was more effective than unilateral pallidotomy regarding tremor, rigidity, and dyskinesias, but it conferred a higher risk of postoperative speech deterioration.