Molinuevo J L, Valldeoriola F, Rumià J, Nobbe F A, Ferrer E, Tolosa E
Servicio de Neurología, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona.
Med Clin (Barc). 2000 Feb 19;114(6):205-8.
To analyze the results, efficacy and safety of unilateral microelectrode guided pallidotomy for the treatment of advanced Parkinson's disease, three months and one year after surgery.
23 patients with advanced Parkinson's disease (mean age 58.9 years and mean disease duration 14.4 years) were submitted to pallidotomy. Neurological evaluation, three months (n = 23) and one year (n = 16) after surgery, was performed during the morning in overnight "off" condition and after receiving 100-150% of their usual l-dopa dose. Parkinsonian symptoms were evaluated in each follow up visit through motor scales, activities of daily living scales, a dyskinesia rating scale and motor timed tests.
Contralateral dyskinesias improved 92% three months after surgery and 89% at one year. Parkinsonian motor scores were reduced by 36.5% after three months and by 26.7% one year after surgery. In the one year follow up visit, contralateral tremor improved 48%, rigidity 36.2% and bradykinesia 37.4%. All these changes were statistically significant (p < 0.01). Adverse effects were minor or transient. Antiparkinsonian medication dosage did not significantly change during the study period.
Microelectrode guided unilateral pallidotomy is an effective and safe procedure to improve contralateral motor symptoms in Parkinson's disease, being specially useful for the treatment of l-dopa induced dyskinesias.
分析单侧微电极引导苍白球毁损术治疗晚期帕金森病术后3个月及1年的结果、疗效和安全性。
23例晚期帕金森病患者（平均年龄58.9岁，平均病程14.4年）接受了苍白球毁损术。术后3个月（n = 23）和1年（n = 16）进行神经学评估，评估在早晨隔夜“关”期且服用其常用左旋多巴剂量的100 - 150%后进行。在每次随访中，通过运动量表、日常生活活动量表、异动症评定量表和运动定时测试对帕金森症状进行评估。
术后3个月对侧异动症改善92%，1年时改善89%。术后3个月帕金森运动评分降低36.5%，术后1年降低26.7%。在1年随访中，对侧震颤改善48%，强直改善36.2%，运动迟缓改善37.4%。所有这些变化均具有统计学意义（p < 0.01）。不良反应轻微或短暂。在研究期间，抗帕金森药物剂量无显著变化。
微电极引导单侧苍白球毁损术是改善帕金森病对侧运动症状的一种有效且安全的方法，对治疗左旋多巴诱发的异动症特别有用。
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