Johansson F, Malm J, Nordh E, Hariz M
Department of Neurology, University Hospital of Northern Sweden, Umeå, Sweden.
J Neurol Neurosurg Psychiatry. 1997 Feb;62(2):125-32. doi: 10.1136/jnnp.62.2.125.
The combined effect of posteroventral pallidotomy and optimal medical treatment was assessed in 22 patients with levodopa sensitive Parkinson's disease.
Timed motor tests, video recordings, and computer assisted optoelectronic movement analysis were used for serial hourly assessments performed preoperatively and four and 12 months after operation. Tests were made while patients were on optimal medical therapy.
There were no serious adverse events of surgery. Two of the 22 patients could not complete all the tests after operation. The proportion of dyskinesia periods decreased in the 20 patients and there was a proportional increase in normal or fairly normal occasions. "Off" periods were not significantly affected. In 12 of 13 patients with limb dyskinesia this symptom was completely abolished in the contralateral limbs. There was also some degree of improvement axially and ipsilaterally. Tremor was moderately improved contralaterally. Bradykinesia remained unchanged. Results at 12 months follow up were similar to those at four months.
Pallidotomy produced a pronounced positive effect on dyskinesia and a moderate effect on tremor. Bradykinesia was not affected. Posteroventral pallidotomy may be useful in patients with Parkinson's disease who have severe motor fluctuations and may allow an increase in levodopa dose to alleviate bradykinesia in "off" states.
评估22例对左旋多巴敏感的帕金森病患者接受腹后苍白球切开术及最佳药物治疗的联合效果。
采用定时运动测试、视频记录及计算机辅助光电运动分析，在术前、术后4个月和12个月进行每小时一次的系列评估。测试在患者接受最佳药物治疗时进行。
手术无严重不良事件。22例患者中有2例术后无法完成所有测试。20例患者的异动症期比例下降，正常或接近正常状态的比例相应增加。“关”期未受显著影响。13例肢体异动症患者中有12例对侧肢体的该症状完全消失。轴向及同侧也有一定程度改善。对侧震颤有中度改善。运动迟缓无变化。12个月随访结果与4个月时相似。
苍白球切开术对异动症有显著积极作用，对震颤有中度作用。运动迟缓未受影响。腹后苍白球切开术可能对有严重运动波动的帕金森病患者有用，并且可能允许增加左旋多巴剂量以缓解“关”状态下的运动迟缓。
