Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD - A randomized trial
Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD - A randomized trial
复制标题
DOI：
10.1212/01.wnl.0000103235.12621.c3
复制
发表时间：
2004-01-27
期刊：
影响因子：
9.9
通讯作者：
Speelman, JD
中科院分区：
文献类型：
--
作者：
Esselink, RAJ;de Bie, RMA;Speelman, JD
目的：在一项随机、双盲、多中心试验中，比较单侧苍白球毁损术和双侧丘脑底核刺激术在晚期帕金森病（PD）患者中的疗效。方法：34例晚期PD患者随机分为单侧苍白球毁损术组和双侧苍白球刺激术组。主要结局是在关闭阶段统一PD评定量表（运动量表）的运动部分从基线到6个月的变化。次要结局为治疗期帕金森病症状（运动障碍量表）、运动障碍（临床运动障碍评定量表和运动障碍量表）、功能状态（日常生活活动量表和Schwab和England量表）、PD生活质量问卷、药物治疗变化和不良反应。结果如下：苍白球切开术组患者的失相运动神经功能缺损评分从46.5分改善至37分，苍白球刺激组患者的失相运动神经功能缺损评分从51.5分改善至26.5分（p=0.002）。在次要结局指标中，同相运动障碍和运动障碍显著改善，有利于电刺激患者。减少抗帕金森病药物是更大的刺激后比苍白球切开术。每组各有1例患者出现严重不良反应。结论：双侧苍白球电刺激比单侧苍白球毁损术更能有效减轻晚期PD患者的帕金森症状。
Objective: To compare the efficacy of unilateral pallidotomy and bilateral subthalamic nucleus (STN) stimulation in patients with advanced Parkinson disease (PD) in a randomized, observer-blind, multicenter trial. Methods: Thirty-four patients with advanced PD were randomly assigned to have unilateral pallidotomy or bilateral STN stimulation. The primary outcome was the change from baseline to 6 months in the motor part of the Unified PD Rating Scale (motor UPDRS) in the off phase. Secondary outcomes were parkinsonian symptoms in the on phase (motor UPDRS), dyskinesias (Clinical Dyskinesia Rating Scale and dyskinesias UPDRS), functional status (activities of daily living UPDRS and Schwab and England scale), PD Quality of Life questionnaire, changes in drug treatment, and adverse effects. Results: The off phase motor UPDRS score improved from 46.5 to 37 points in the group of pallidotomy patients and from 51.5 to 26.5 in the STN stimulation patients (p=0.002). Of the secondary outcome measures, on phase motor UPDRS and dyskinesias UPDRS improved significantly in favor of the STN stimulation patients. Reduction of antiparkinsonian drugs was greater after STN stimulation than after pallidotomy. One patient in each group had a major adverse effect. Conclusions: Bilateral STN stimulation is more effective than unilateral pallidotomy in reducing parkinsonian symptoms in patients with advanced PD.