Visser-Vandewalle Veerle, van der Linden Chris, Temel Yasin, Nieman Fred, Celik Halime, Beuls Emile
Department of Neurosurgery, Academic Hospital Maastricht, The Netherlands.
J Neurosurg. 2003 Oct;99(4):701-7. doi: 10.3171/jns.2003.99.4.0701.
The aim of this study was to evaluate the long-term effects of unilateral pallidal stimulation on motor function in selected patients with advanced Parkinson disease (PD).
The authors enrolled 26 patients with idiopathic PD in whom there was an asymmetric distribution of symptoms and, despite optimal pharmocological treatment, severe response fluctuations and/or dyskinesias. After the patient had received a local anesthetic agent, a quadripolar electrode (Medtronic model 3387) was implanted at the side opposite the side affected or, if both sides were affected, the side contralateral to the more affected side. No serious complications occurred. After 3 months, the total Unified PD Rating Scale (UPDRS) Part III score decreased by 50.7% while patients were in the off-medication state (from 26.5 +/- 9.2 to 13.1 +/- 6.1) and by 55.4% while they were in the on-medication state (from 10.6 +/- 6.3 to 4.7 +/- 4.4). Only during the on state was the contralateral effect clearly more pronounced. The UPDRS Part IVa score decreased by 75% (from 3.7 +/- 2.5 to 0.9 +/- 1.1) and the UPDRS Part IVb score by 54.7% (from 3.3 +/- 1.3 to 1.5 +/- 1.3). At long-term follow-up review (32.7 +/- 10.7 months), there was an 8.3% increase in the UPDRS Part III score while patients were in the off state (from 26.5 +/- 9.2 to 28.7 +/- 7.6) and a 40.2% increase in this score while patients were in the on state (from 10.6 +/- 6.3 to 14.9 +/- 5.1). The UPDRS Part IVa score decreased by 28.1% (from 3.7 +/- 2.5 to 2.7 +/- 2.3) and the UPDRS Part IVb score increased by 3.5% (from 3.3 +/- 1.3 to 3.4 +/- 1.6).
Based on these unsatisfactory results at long-term review, the authors conclude that unilateral pallidal stimulation is not an effective treatment option for patients with advanced PD.
本研究旨在评估单侧苍白球刺激对部分晚期帕金森病（PD）患者运动功能的长期影响。
作者招募了26例特发性PD患者，这些患者症状分布不对称，尽管接受了最佳药物治疗，但仍有严重的反应波动和/或异动症。在患者接受局部麻醉剂后，将四极电极（美敦力3387型号）植入受影响侧的对侧，如果双侧均受影响，则植入受影响更严重侧的对侧。未发生严重并发症。3个月后，在患者未服药状态下，统一帕金森病评定量表（UPDRS）第三部分总分下降了50.7%（从26.5±9.2降至13.1±6.1），在服药状态下下降了55.4%（从10.6±6.3降至4.7±4.4）。仅在服药状态下，对侧效应明显更显著。UPDRS第四部分a评分下降了75%（从3.7±2.5降至0.9±1.1），UPDRS第四部分b评分下降了54.7%（从3.3±1.3降至1.5±1.3）。在长期随访复查（32.7±10.7个月）时，在患者未服药状态下，UPDRS第三部分评分增加了8.3%（从26.5±9.2增至28.7±7.6），在服药状态下该评分增加了40.2%（从10.6±6.3增至14.9±5.1）。UPDRS第四部分a评分下降了28.1%（从3.7±2.5降至2.7±2.3），UPDRS第四部分b评分增加了3.5%（从3.3±1.3增至3.4±1.6）。
基于长期复查的这些不理想结果，作者得出结论，单侧苍白球刺激对晚期PD患者不是一种有效的治疗选择。
