Lozano A M, Lang A E, Galvez-Jimenez N, Miyasaki J, Duff J, Hutchinson W D, Dostrovsky J O
Department of Surgery, Toronto Hospital Neurological Centre, Canada.
Lancet. 1995 Nov 25;346(8987):1383-7. doi: 10.1016/s0140-6736(95)92404-3.
The major motor disturbances in Parkinson's disease are thought to be caused by overactivity of the internal segment of the globus pallidus (GPi), in large part due to excessive drive from the subthalamic nucleus. The excessive inhibitory activity of GPi is thought to "brake' the motor thalamus and the cortical motor system to produce the slowness, rigidity, and poverty of movement characteristic of parkinsonian states. To test the hypothesis that direct reduction of Gpi activity can improve motor function, we studied the effect of GPi pallidotomy in 14 patients. The location of the GPi nucleus was confirmed by microelectrode recording before lesion creation. Standardised videotape recordings before and after operation were randomised and scored by a "blinded' evaluator. 6 months after surgery, total motor score in the "off" state had improved by 30% and the total akinesia score by 33%. The gait score in the "off" state improved by 15% and a composite postural instability and gait score by 23%. After surgery there was almost total elimination of drug-induced involuntary movements (dyskinesias), with a 92% reduction on the side contralateral to the pallidotomy. No patient had visual or corticospinal complications. In these patients GPi pallidotomy enhanced motor performance, reduced akinesia, improved gait, and eliminated the neural elements responsible for levodopa-induced dyskinesias.
帕金森病的主要运动障碍被认为是由苍白球内侧部（GPi）活动过度引起的，在很大程度上是由于来自底丘脑核的驱动过度。GPi的过度抑制活动被认为会“制动”运动丘脑和皮质运动系统，从而产生帕金森状态所特有的运动迟缓、僵硬和运动减少。为了验证直接降低GPi活动可以改善运动功能这一假设，我们研究了14例患者接受GPi苍白球切开术的效果。在进行损伤之前，通过微电极记录来确认GPi核的位置。手术前后的标准化录像带记录被随机化，并由一位“不知情”的评估者进行评分。术后6个月，“关”状态下的总运动评分提高了30%，总运动不能评分提高了33%。“关”状态下的步态评分提高了15%，姿势不稳和步态综合评分提高了23%。手术后，药物诱导的不自主运动（异动症）几乎完全消除，苍白球切开术对侧减少了92%。没有患者出现视觉或皮质脊髓并发症。在这些患者中，GPi苍白球切开术提高了运动表现，减少了运动不能，改善了步态，并消除了左旋多巴诱导的异动症的神经因素。
