Horisawa Shiro, Nanke Magi, Kawamata Takakazu, Taira Takaomi
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
World Neurosurg. 2019 Jan;121:193-195. doi: 10.1016/j.wneu.2018.10.055. Epub 2018 Oct 15.
The pallidothalamic tract connects the globus pallidus internus and the ventrolateral portion of the thalamus, and ablation of the pallidothalamic tract (pallidothalamic tractotomy [PTT]) reportedly exerts antiparkinsonian effects. However, the detailed clinical course has not yet been elucidated. Here, we present the first single case report of PTT performed in a patient with Parkinson disease, with 1-year follow-up.
The patient was a 68-year-old woman with Parkinson disease. After 14 years of receiving oral medication, she experienced the "wearing-off" phenomenon. Levodopa (300 mg/day) was required to maintain daily activities. Rigidity and peak-dose dyskinesia were predominantly observed in the right side of her body. In addition, she demonstrated right foot dystonia with pain. The preoperative Unified Parkinson Disease Rating Scale part 1, 2 (off medication/on medication), 3 (off medication/on medication), and 4 scores were 7, 26/4, 41/23, and 13, respectively. Further, the preoperative Unified Dyskinesia Rating Scale and Parkinson Disease Questionnaire-39 scores were 102 and 46, respectively. She underwent left-sided PTT, and no perioperative complications were observed. At 1 year postoperatively, daily administration of levodopa (200 mg) was maintained without an "off" condition all day. The 1-year Unified Parkinson Disease Rating Scale part 1, 2, 3, and 4 scores were 5, 9/1, 20/12, and 5, respectively. In addition, the 1-year Unified Dyskinesia Rating Scale and Parkinson Disease Questionnaire-39 scores were 20 and 20, respectively.
We present a rare case of PTT performed in a patient with Parkinson disease. PTT might be useful in patients who do not desire device implantation.
苍白球丘脑束连接苍白球内侧部和丘脑腹外侧部分，据报道，切断苍白球丘脑束（苍白球丘脑束切断术[PTT]）可产生抗帕金森病作用。然而，其详细的临床过程尚未阐明。在此，我们首次报告了1例帕金森病患者接受PTT手术并随访1年的病例。
该患者为一名68岁的帕金森病女性。口服药物治疗14年后，出现“剂末现象”。维持日常活动需要左旋多巴（300毫克/天）。右侧身体主要表现为强直和剂峰异动症。此外，她还出现了伴有疼痛的右脚肌张力障碍。术前统一帕金森病评定量表第1、2部分（未用药/用药时）、第3部分（未用药/用药时）和第4部分评分分别为7分、26/4分、41/23分和13分。此外，术前统一异动症评定量表和帕金森病问卷-39评分分别为102分和46分。她接受了左侧PTT手术，未观察到围手术期并发症。术后1年，每天维持服用左旋多巴（200毫克），全天无“关”期。术后1年统一帕金森病评定量表第1、2、3和4部分评分分别为5分、9/1分、20/12分和5分。此外，术后1年统一异动症评定量表和帕金森病问卷-39评分分别为20分和20分。
我们报告了1例罕见的帕金森病患者接受PTT手术的病例。PTT可能对不希望植入设备的患者有用。
