Unilateral and bilateral pallidotomy for idiopathic Parkinson's disease: A case series of 115 patients
Unilateral and bilateral pallidotomy for idiopathic Parkinson's disease: A case series of 115 patients
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DOI：
10.1002/mds.10186
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发表时间：
2002-07-01
影响因子：
8.6
通讯作者：
Aziz, TZ
中科院分区：
文献类型：
--
作者：
Parkin, SG;Gregory, RP;Aziz, TZ
内苍白球的损伤被认为可以改善特发性帕金森病（PD）的症状，并减轻与左旋多巴治疗相关的运动障碍和运动波动。在某些情况下，当症状为双侧致残时，单个病变对侧获得的获益不足。然而，双侧苍白球切开术后不良反应发生率高得令人无法接受的报道限制了其在此类病例中的应用。我们报告了在英国和澳大利亚的115例PD患者中进行单侧（UPVP）和双侧（BPVP）后腹苍白球切开术的结果。3个月后，UPVP导致停药第III部分（运动）统一帕金森病评定量表评分降低27%，40%的病例运动障碍消失。对于BPVP，这些数字分别增加到31%和63%。对一个较小的组进行了12个月的随访，发现运动评分恶化，但对运动障碍和日常生活活动的益处得以维持。BPVP后言语受到不利影响，尽管在大多数情况下变化很小。单侧和双侧苍白球切开术可以安全地进行，而无需微电极定位。双侧苍白球切开术似乎更有效，特别是在减少运动障碍方面，在经验之外，副作用没有其他组报道的那么高。(C)2002运动障碍协会。
Lesioning of the internal pallidum is known to improve the symptoms of idiopathic Parkinson's disease (PD) and alleviate dyskinesia and motor fluctuations related to levodopa therapy. The benefit obtained contralateral to a single lesion is insufficient in some cases when symptoms are bilaterally disabling. However, reports of unacceptably high rates of adverse effects after bilateral pallidotomy have limited its use in such cases. We report on the outcome of unilateral (UPVP) and bilateral (BPVP) posteroventral pallidotomy in a consecutive case series of 115 patients with PD in the United Kingdom and Australia. After 3 months, UPVP resulted in a 27% reduction in the off medication Part III (motor) Unified Parkinson's Disease Rating Scale score and abolition of dyskinesia in 40% of cases. For BPVP, these figures were increased to 31% and 63%, respectively. Follow-up of a smaller group to 12 months found the motor scores to be worsening, but benefit to dyskinesia and activities of daily living was maintained. Speech was adversely affected after BPVP, although the change was small in most cases. Unilateral and bilateral pallidotomy can be performed safely without microelectrode localisation. Bilateral pallidotomy appears to be more effective, particularly in reducing dyskinesia in out-experience, the side effects have not been as high as reported by other groups. (C) 2002 Movement Disorder Society.