Taha J M, Favre J, Baumann T K, Burchiel K J
Division of Neurosurgery, Oregon Health Sciences University, Portland, USA.
J Neurosurg. 1997 Apr;86(4):642-7. doi: 10.3171/jns.1997.86.4.0642.
The goals of this study were to analyze the effect of pallidotomy on parkinsonian tremor and to ascertain whether an association exists between microrecording findings and tremor outcome. Forty-four patients with Parkinson's disease who had drug-induced dyskinesia, bradykinesia, rigidity, and tremor underwent posteroventral pallidotomy. Using a 1-mu-tip tungsten electrode, microrecordings were obtained through one to three tracts, starting 10 mm above the pallidal base. Tremor severity was measured on a patient-rated, 100-mm Visual Analog Scale (VAS), both preoperatively and 3 to 9 months (mean 6 months) postoperatively. Preoperatively, tremor was rated as 50 mm or greater in 24 patients (55%) and as less than 25 mm in 13 patients (30%). Postoperatively, tremor was rated as 50 mm or greater in five patients (11%) and less than 25 mm in 29 patients (66%). The difference was significant (p = 0.0001). Four patients (9%) had no postoperative tremor. Tremor improved by at least 50% in eight (80%) of 10 patients in whom tremor-synchronous cells were recorded (Group A) and in 12 (35%) of 34 patients in whom tremor-synchronous cells were not recorded (Group B). This difference was significant (p = 0.03). Tremor improved by at least 50 mm in all (100%) of the seven Group A patients with severe (> or = 50 mm) preoperative tremor and in nine (53%) of 17 Group B patients with severe preoperative tremor. This difference was also significant (p = 0.05). The authors prefer two conclusions: 1) after pallidotomy, tremor improves by at least 50% in two-thirds of patients with Parkinson's disease who have severe (> or = 50 mm on the VAS) preoperative tremor; and 2) better tremor control is obtained when tremor-synchronous cells are included in the lesion.
本研究的目的是分析苍白球切开术对帕金森病震颤的影响，并确定微记录结果与震颤结局之间是否存在关联。44例患有药物性异动症、运动迟缓、肌强直和震颤的帕金森病患者接受了腹后苍白球切开术。使用1微电极，通过一至三条轨迹进行微记录，起始点在苍白球底部上方10毫米处。在术前以及术后3至9个月（平均6个月），采用患者自评的100毫米视觉模拟量表（VAS）对震颤严重程度进行测量。术前，24例患者（55%）的震颤评分为50毫米或更高，13例患者（30%）的震颤评分为小于25毫米。术后，5例患者（11%）的震颤评分为50毫米或更高，29例患者（66%）的震颤评分为小于25毫米。差异具有统计学意义（p = 0.0001）。4例患者（9%）术后无震颤。在记录到震颤同步细胞的10例患者中的8例（80%）（A组）以及未记录到震颤同步细胞的34例患者中的12例（35%）（B组）中，震颤改善至少50%。这一差异具有统计学意义（p = 0.03）。在术前震颤严重（≥50毫米）的7例A组患者中，所有患者（100%）的震颤改善至少50毫米，在术前震颤严重的17例B组患者中的9例（53%）也是如此。这一差异同样具有统计学意义（p = 0.05）。作者倾向于两个结论：1）在苍白球切开术后，术前震颤严重（VAS评分≥50毫米）的帕金森病患者中，三分之二的患者震颤改善至少50%；2）当毁损灶包含震颤同步细胞时，可获得更好的震颤控制。
