Department of Functional Neurosurgery, Hospital Santa Marcelina, São Paulo, Brazil.
Division of Functional Neurosurgery, Institute of Psychiatry of Hospital das Clínicas, University of São Paulo, Medicine School, São Paulo, Brazil.
Neurosurgery. 2019 Oct 1;85(4):E650-E659. doi: 10.1093/neuros/nyz039.
Stereotactic lesion in the Forel's field H (campotomy) was proposed in 1963 to treat Parkinson disease (PD) symptoms. Despite its rationale, very few data on this approach have emerged. Additionally, no study has assessed its effects on nonmotor symptoms, neuropsychological functions and quality of life.
To provide a prospective 2-yr assessment of motor, nonmotor, neuropsychological and quality of life variables after unilateral campotomy.
Twelve PD patients were prospectively evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), the Dyskinesia Rating Scale and the Parkinson's disease quality of life questionnaire (PDQ39) before campotomy, and after 6 and 24 mo. Nonmotor, neuropsychiatric, neuropsychological and quality of life variables were assessed. The impact of PD on global health was also rated.
A significant reduction in contralateral rest tremor (65.7%, P < .001), rigidity (87.8%, P < .001), bradykinesia (68%, P < .001) and axial symptoms (24.2%, P < .05) in offmedication condition led to a 43.9% reduction in UPSDRS III scores 2 yr after campotomy (P < .001). Gait improved by 31.9% (P < .05) and walking time to cover 7 m was reduced by 43.2% (P < .05). Pain decreased by 33.4% (P < .01), while neuropsychiatric and neuropsychological functions did not change. Quality of life improved by 37.8% (P < .05), in line with a 46.7% reduction of disease impact on global health (P < .001).
A significant 2-yr improvement of motor symptoms, gait performance and pain was obtained after unilateral campotomy without significant changes to cognition. Quality of life markedly improved in parallel with a significant reduction of PD burden on global health.
1963 年，有人提出在 Forel 场 H（campotomy）进行立体定位损伤以治疗帕金森病（PD）症状。尽管有其理论依据，但关于这种方法的数据却很少。此外，尚无研究评估其对非运动症状、神经心理学功能和生活质量的影响。
提供单侧 campotomy 后 2 年运动、非运动、神经心理学和生活质量变量的前瞻性评估。
12 例 PD 患者在 campotomy 前、术后 6 个月和 24 个月分别使用统一帕金森病评定量表（UPDRS）、不自主运动评定量表和帕金森病生活质量问卷（PDQ39）进行前瞻性评估。评估非运动、神经精神、神经心理学和生活质量变量。还评估了 PD 对整体健康的影响。
在停药状态下，对侧静止性震颤（65.7%，P<.001）、僵直（87.8%，P<.001）、运动迟缓（68%，P<.001）和轴性症状（24.2%，P<.05）显著减少，导致 campotomy 后 2 年 UPDRS III 评分降低 43.9%（P<.001）。步态改善 31.9%（P<.05），7 米行走时间减少 43.2%（P<.05）。疼痛减轻 33.4%（P<.01），而神经心理学和神经心理学功能没有变化。生活质量提高了 37.8%（P<.05），与疾病对整体健康影响降低 46.7%（P<.001）一致。
单侧 campotomy 后，运动症状、步态表现和疼痛显著改善 2 年，认知功能无显著变化。生活质量显著改善，同时 PD 对整体健康的负担显著减轻。
