帕金森病患者单侧苍白球切开术后对侧苍白球切开术与苍白球刺激术的比较。

Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK.

Neuromodulation. 2011 Mar-Apr;14(2):117-22; discussion 122. doi: 10.1111/j.1525-1403.2010.00318.x. Epub 2010 Dec 13.

OBJECTIVES

Pallidal stimulation and pallidotomy are known to improve the symptoms of Parkinson's disease (PD). However, it is not known which modality produces greater benefit in patients who have already undergone unilateral pallidotomy. It is also suggested that the original pallidal surgery provides a greater benefit than subsequent pallidal surgery. The aim of this study was to analyze which modality produced greater PD symptom improvement in patients with a prior pallidotomy and whether the chronological order of the pallidal surgery influenced the size of the improvement.

METHODS

Five patients who had undergone a prior unilateral pallidotomy for PD were studied. Because of ongoing Parkinsonian symptoms, all patients subsequently underwent contralateral pallidal surgery, either a further pallidotomy or pallidal stimulation. All surgeries were performed by a single functional neurosurgeon and the patients prospectively assessed and scored at routine follow-ups. Paired-sample t-tests were used to detect differences in outcomes after first and second surgeries.

RESULTS

Two patients underwent pallidal stimulation and three underwent a second pallidotomy. Mean follow-up was 13.5 months and 12.3 months, respectively. Greater percentage improvements in the majority of scores were found after pallidal stimulation compared with a second pallidotomy, namely Unified Parkinson's Disease Rating Scale (UPDRS) II off (25.22% vs. -3.27%), UPDRS III off (36.15% vs. 5.21%), rigidity (58.34% vs. 11.54%), tremor (5.56% vs. -30.48%), bradykinesia (48.55% vs. -2.23%), gait composite (16.52% vs. -51.79%), dyskinesia duration (83.33% vs. 66.67%), dyskinesia disability (100% vs. 66.67%), speech (10% vs. -50%), and the proportion of the day spent in the "off" state (50% vs. 25%). Comparing outcomes after the first surgery to those after the second surgery, statistical differences were found in dyskinesia duration improvement and ipsilateral dyskinesia improvement after the second surgery (p < 0.004 and p = 0.021, respectively).

CONCLUSIONS

Pallidal stimulation produced greater symptom improvement than a second pallidotomy and subsequent surgery did not produce inferior results to the original pallidal surgery.

目的

苍白球刺激和苍白球切开术已被证明可改善帕金森病（PD）的症状。然而，对于已经接受单侧苍白球切开术的患者，哪种治疗方式能带来更大的益处尚不清楚。也有人认为，原始苍白球手术的效果优于后续的苍白球手术。本研究的目的是分析对于已经接受过单侧苍白球切开术的患者，哪种治疗方式能带来更大的 PD 症状改善，以及苍白球手术的时间顺序是否会影响改善的程度。

方法

研究了 5 名因 PD 而行单侧苍白球切开术的患者。由于持续存在帕金森病症状，所有患者随后接受了对侧苍白球手术，包括进一步的苍白球切开术或苍白球刺激术。所有手术均由同一位功能性神经外科医生进行，患者在常规随访中进行前瞻性评估和评分。采用配对样本 t 检验检测两次手术后结果的差异。

结果

2 名患者接受了苍白球刺激术，3 名患者接受了第二次苍白球切开术。平均随访时间分别为 13.5 个月和 12.3 个月。与第二次苍白球切开术相比，苍白球刺激术在大多数评分上的百分比改善更大，即统一帕金森病评定量表（UPDRS）Ⅱ期停药（25.22% vs. -3.27%）、UPDRS Ⅲ期停药（36.15% vs. 5.21%）、僵直（58.34% vs. 11.54%）、震颤（5.56% vs. -30.48%）、运动迟缓（48.55% vs. -2.23%）、步态综合（16.52% vs. -51.79%）、异动症持续时间（83.33% vs. 66.67%）、异动症残疾（100% vs. 66.67%）、言语（10% vs. -50%）和日间“关期”比例（50% vs. 25%）。与第一次手术后的结果相比，第二次手术后的异动症持续时间改善和同侧异动症改善具有统计学差异（p < 0.004 和 p = 0.021）。