Assessment of pallidotomy on physiological and cognitive functions after stereotactic pallidotomy

我们研究了12例帕金森病患者(男6例，女2例)行苍白球内核切开术(苍白球切开术)对帕金森症状、认知功能和长潜伏期牵拉反射的影响。手术采用微电极和CT导引。12例患者的平均年龄为54.1“+”12.6岁(范围29-71岁)，帕金森病的平均病程为6.5“+”5.2岁(范围2-18岁)。根据美国帕金森病评定量表(UPDRS)对患者进行评估。这些评估是在药物治疗的“疲劳期”进行评级的。治疗后1个月心理、行为、情绪平均改善81.8%(配对t检验P&lt；0.05)。1个月平均日常生活能力评分提高了44.0%(p&lt；0.01)，1个月平均运动检查提高了53.9%(p&lt；0.001)。手术导致对侧和同侧肢体僵硬和运动迟缓的显著改善。静止性震颤在对侧有所改善，但在同侧没有改善。对4例患者在手术前后进行神经心理测试。注意力、记忆力和额叶功能在术后1个月内有所下降，术后1~3个月恢复正常。这种认知功能的短期下降可能是由于外科手术对大脑的侮辱造成的。6例患者术前、术后分别测定前臂屈肌的伸展反射。术后对侧手的长潜伏期牵拉反射波幅降低。这种变化可能与刚性的提高有关。

We studied the effects of posterior internal pallidal ablation (pallidotomy) on parkinsonian symptoms, cognitive function and the long-latency stretch reflex in 12 parkinsonian patients (6 men and 2 women). The surgery was performed using microelectrode and CT guiding. The mean age of the 12 study patients was 54.1 "+"12.6 years (range, 29 - 71) and the mean duration of Parkinson's disease was 6.5 "+" 5.2 (range, 2 - 18). Patients were evaluated according to the United Parkinson's Disease Rating Scale (UPDRS). The evaluations were rated during "wearing-off' period with medication. The 1-month mean subscale of Mentation, Behavior and Mood improved by 81.8% (p < 0.05 by paired t-test). The 1-month mean ADL subscale improved by 44.0% (p < 0.01) and the 1-month mean Motor Examination improved by 53.9% (p < 0.001). Surgery resulted in marked contralateral and moderate ipsilateral amelioration of limb rigidity and bradykinesia. Rest tremor was ameliorated on the contralateral side but not on the ipsilateral side. Neuropsychological testing was performed before and after the surgery in 4 patients. There was post-surgical decline on attention, memory and frontal lobe function within 1 month after surgery, but these functions recovered 1-3 months after surgery. This shot-term decline of cognitive function may be cause by surgical insult to the brain. Stretch reflex of the forearm flexors was measured before and after the surgery in 6 patients. The amplitude of the long-latency stretch reflex of the contralateral hand decreased after surgery. This change may be related to improvement of rigidity.