Assessment of pallidotomy on physiological and cognitive functions after stereotactic pallidotomy

我们研究了12名帕金森病患者（6名男性和2名女性）的后内侧苍白球消融术（苍白球切开术）对帕金森病症状、认知功能和长潜伏期牵张反射的影响。手术采用微电极和CT引导。12例研究患者的平均年龄为54.1 ± 12.6岁（范围：29 - 71岁），帕金森病的平均病程为6.5 ± 5.2（范围：2 - 18岁）。根据联合帕金森病评定量表（United Parkinson's Disease Rating Scale，简称CAFRS）对患者进行评估。在药物“逐渐消失”期间对评价进行评级。心理、行为和情绪的1个月平均分量表改善了81.8%（配对t检验p < 0.05）。1个月平均ADL子量表改善44.0%（p < 0.01），1个月平均运动检查改善53.9%（p < 0.001）。手术导致对侧和同侧肢体僵硬和运动迟缓明显改善。对侧静息震颤改善，但同侧无改善。4例患者在手术前后进行神经心理学测试。术后1个月内注意力、记忆力和额叶功能均有所下降，术后1-3个月恢复。认知功能的短期下降可能是由对大脑的手术损伤引起的。对6例患者术前、术后前臂屈肌群的牵张反射进行了测定。手术后对侧手长潜伏期牵张反射的振幅降低。这种变化可能与刚度的改善有关。

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.