Kumar R, Lang A E, Rodriguez-Oroz M C, Lozano A M, Limousin P, Pollak P, Benabid A L, Guridi J, Ramos E, van der Linden C, Vandewalle A, Caemaert J, Lannoo E, van den Abbeele D, Vingerhoets G, Wolters M, Obeso J A
Division of Neurology and Neurosurgery, University of Toronto Medical School, Ontario, Canada.
Neurology. 2000;55(12 Suppl 6):S34-9.
Pallidotomy is now widely performed for the treatment of advanced Parkinson's disease (PD). Preliminary reports of the effect of globus pallidus pars interna deep brain stimulation (GPi DBS) have also been promising. We have analyzed a cohort of 22 consecutive patients enrolled in a multicenter study. Surgery was bilateral in 17 and unilateral in five patients. At 6-month follow-up, the bilaterally GPi-implanted patients demonstrated a marked improvement when examined after drug withdrawal ("off") and under optimal medication ("on") using the Unified Parkinson's Disease Rating Scale (UPDRS). The benefit induced by the stimulation in the "off" medication condition in the total motor score was 31% and in the activities of daily living (ADL) scores was 39%. During the "on" medication period, the reduction in the total "on" dyskinesias score was 66% and in the ADL score was 32%. A similar pattern of improvement was seen in the group of patients with unilateral GPi stimulation, although a second cohort of 12 patients not included in the multicenter study showed greater improvements in "on" motor functioning. Although the effect of DBS is predominantly reversible, electrode insertion alone resulted in measurable clinical effects in the absence of stimulation. Thus, at 6-month follow-up, the benefit observed without stimulation was up to 44% in the "on" dyskinesias score and 29% in timed tapping scores undertaken in the "off" medication state. Complications among 34 patients from all centers included perioperative infection (n=3), hardware fracture (n=2), and premature battery failure (n=3). These results show a positive antiparkinsonian effect of pallidal DBS. No specific complications were observed with bilateral procedures.
苍白球切开术目前已广泛用于治疗晚期帕金森病（PD）。内侧苍白球深部脑刺激（GPi DBS）效果的初步报告也很有前景。我们分析了一组连续纳入多中心研究的22例患者。17例患者接受双侧手术，5例接受单侧手术。在6个月的随访中，使用统一帕金森病评定量表（UPDRS）对双侧植入GPi的患者在撤药状态下（“关”期）和最佳药物治疗状态下（“开”期）进行检查时，发现有显著改善。刺激在“关”期药物状态下对总运动评分的改善率为31%，对日常生活活动（ADL）评分的改善率为39%。在“开”期药物治疗期间，“开”期异动症总评分降低了66%，ADL评分降低了32%。单侧GPi刺激组患者也出现了类似的改善模式，尽管未纳入多中心研究的另一组12例患者在“开”期运动功能方面有更大改善。尽管DBS的效果主要是可逆的，但在无刺激的情况下，仅电极插入就产生了可测量的临床效果。因此，在6个月的随访中，在“开”期异动症评分方面，无刺激时观察到的改善率高达44%，在“关”期药物状态下进行的定时敲击评分方面为29%。所有中心的34例患者出现的并发症包括围手术期感染（n = 3）、硬件故障（n = 2）和电池过早失效（n = 3）。这些结果显示苍白球DBS具有积极的抗帕金森病效果。双侧手术未观察到特定并发症。
