Baron M S, Vitek J L, Bakay R A, Green J, McDonald W M, Cole S A, DeLong M R
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Mov Disord. 2000 Mar;15(2):230-7. doi: 10.1002/1531-8257(200003)15:2<230::aid-mds1005>3.0.co;2-u.
To assess the long-term outcome following unilateral pallidotomy for advanced Parkinson's disease, we performed nonblinded Core Assessment Program for Intracerebral Transplantations protocol assessments in 10 of the original 15 patients in our pilot study for 4 years following surgery. Although Unified Parkinson's Disease Rating Scale motor examination scores returned to baseline levels at 3 and 4 years, most patients continued to show sustained improvements in contralateral tremor, akinesia, and drug-induced dyskinesias. Contralateral tremor was absent at 4 years in all seven patients with preoperative tremor. Contralateral "off" arm movement times (averaged for three tasks) decreased by 37% at 1 year and by 30% at 4 years. Contralateral dyskinesia scores improved by 82% at 1 year and by 64% at 4 years. In contrast, after reaching speeds equal to the contralateral side at 1 year, ipsilateral "off" movement times increased by 13% over baseline levels at 4 years. Although most gait and postural stability measures showed modest initial improvement followed by a return to baseline values, "on" stand-walk-sit task performance declined significantly at 4 years. Despite the restriction of our surgeries to one side and the expected natural progression of Parkinson's disease, the results of patient self-assessments suggest that 4 years after unilateral pallidotomy, most patients continue to experience a quality of life above preoperative levels.
为评估单侧苍白球切开术治疗晚期帕金森病的长期疗效，我们对试点研究中最初15例患者中的10例在术后4年进行了非盲法的脑内移植核心评估程序方案评估。尽管统一帕金森病评定量表运动检查评分在3年和4年时恢复到基线水平，但大多数患者对侧震颤、运动不能和药物诱发的异动症仍持续改善。术前有震颤的7例患者在4年时对侧震颤均消失。对侧“关”期手臂运动时间（三项任务的平均值）在1年时下降了37%，在4年时下降了30%。对侧异动症评分在1年时改善了82%，在4年时改善了64%。相比之下，在1年时达到对侧速度后，同侧“关”期运动时间在4年时比基线水平增加了13%。尽管大多数步态和姿势稳定性指标最初有适度改善，随后又恢复到基线值，但“开”期坐-立-走任务表现在4年时显著下降。尽管我们的手术仅限于一侧，且帕金森病有预期的自然进展，但患者自我评估结果表明，单侧苍白球切开术后4年，大多数患者的生活质量仍高于术前水平。
