Reassessment of unilateral pallidotomy in Parkinson's disease. A 2-year follow-up study.
Reassessment of unilateral pallidotomy in Parkinson's disease. A 2-year follow-up study.
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帕金森病单侧苍白球切开术的重新评估。
DOI：
10.1093/brain/122.3.417
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
D. Calne
中科院分区：
文献类型：
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作者：
A. Samii;I. Turnbull;A. Kishore;M. Schulzer;E. Mak;S. Yardley;D. Calne
单侧苍白球切开术在治疗帕金森氏病的运动症状方面越来越受欢迎。我们介绍了一项为期两年的苍白球切开术后随访研究的结果。采用统一帕金森病评定量表(UPDRS)、Goetz运动障碍评定量表和普渡钉板试验(PPBT)对20例苍白球摘除术后2年的患者进行定期停药和服药评估。从苍白球摘除前3个月到苍白球摘除后2年，抗帕金森病药物的剂量没有明显变化。在手术的对侧，运动障碍(从苍白球术前减少83%到苍白球术后2年，P<；0.001)和关闭状态震颤(从苍白球术前减少90%到苍白球术后2年，P=0.005)均有改善。在同侧运动障碍、轴性运动障碍、PPBT‘OFF’或‘ON’状态、‘OFF’状态日常生活活动能力(ADL)、‘OFF’状态步态和姿势稳定性方面，苍白球切开术前和术后2年的评分差异均无统计学意义。2年后，与苍白球切开术前相比，‘on’状态下的日常生活能力评分下降了75%(P=0.005)。我们得出的结论是，苍白球切开术2年后，苍白球切开术对侧运动障碍和震颤的改善得以保留，而大多数其他缺陷的最初改善则消失，要么是因为病理进展，要么是因为失去了手术所取得的早期疗效。
Unilateral pallidotomy has gained popularity in treating the motor symptoms of Parkinson's disease. We present the results of a 2-year post-pallidotomy follow-up study. Using the Unified Parkinson's Disease Rating Scale (UPDRS), the Goetz dyskinesia scale and the Purdue Pegboard Test (PPBT), we evaluated 20 patients at regular intervals both off and on medications for 2 years post-pallidotomy. There were no significant changes in the dosages of antiparkinsonian medications from 3 months pre-pallidotomy to 2 years post-pallidotomy. On the side contralateral to the operation, the improvements were preserved in 'on'-state dyskinesia (83% reduction from pre-pallidotomy to 2 years post-pallidotomy, P < 0.001) and 'off'-state tremor (90% reduction from pre-pallidotomy to 2 years post-pallidotomy, P = 0.005). There were no statistically significant differences between pre-pallidotomy scores and those at 2 years post-pallidotomy in ipsilateral dyskinesia, axial dyskinesia, 'off'- or 'on'-state PPBT, 'off'-state Activities of Daily Living (ADL) and 'off'-state gait and postural stability. After 2 years, the 'on'-state ADL scores worsened by 75%, compared with pre-pallidotomy (P = 0.005). We conclude that 2 years after pallidotomy, the improvements in dyskinesia and tremor on the side contralateral to pallidotomy are preserved, while the initial improvements in most other deficits disappear, either because of progression of pathology or loss of the early efficacy achieved by surgery.