Watts R L, Subramanian T, Freeman A, Goetz C G, Penn R D, Stebbins G T, Kordower J H, Bakay R A
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Exp Neurol. 1997 Oct;147(2):510-7. doi: 10.1006/exnr.1997.6626.
Studies in nonhuman primates with experimental parkinsonism have shown that intrastriatal cografts of autologous adrenal medulla and peripheral nerve yield greater behavioral improvement and graft survival than do adrenal medulla grafts alone. To test these observations, five patients with advanced Parkinson's disease were selected to receive unilateral intrastriatal adrenal medulla-intercostal nerve cografts. They were evaluated using the Core Assessment Program for Intracerebral Transplantation (CAPIT) protocol. Three of these patients also underwent quantitative motor testing for the measurement of upper limb bradykinesia (movement time; MT). Following right flank adrenalectomy, cografts consisting of small fragments of adrenal medullary tissue and minced intercostal nerve were stereotaxically implanted into three targets in the right striatum using computerized tomography guidance. Surgery was uneventful and postoperative magnetic resonance imaging revealed accurate placement of the grafts. No morbidity was encountered. Results of 24 months of clinical and quantitative motor assessments postoperatively are reported. Total UPDRS motor scores in the "off" state improved from a mean preoperative score of 39.5 to 32.1 at 3, 29.7 at 6, 27.6 at 9, 28.5 at 12, 31.4 at 18, and 26.5 at 24 months after surgery. Total timed motor test scores during the "off" state improved 17.9% at 6, 23.3% at 9, 18.2% at 12, 38.2% at 18, and 34.9% at 24 months postoperatively compared to baseline. Movement time showed statistically significant improvement (repeated measures ANOVA, P < 0.05) in the left arm (contralateral to surgery) in all three patients tested. These results indicate that stereotaxic intrastriatal implantation of autologous adrenal medulla-peripheral nerve cografts can be performed safely and clinical improvement from this procedure is sustained for a period of 24 months. The clinical improvement was paralleled by improvement in objective, quantitative motor testing.
对患有实验性帕金森病的非人类灵长类动物的研究表明，与单独的肾上腺髓质移植相比，自体肾上腺髓质和周围神经的纹状体内联合移植能带来更大的行为改善和移植存活率。为了验证这些观察结果，选择了5例晚期帕金森病患者接受单侧纹状体内肾上腺髓质 - 肋间神经联合移植。使用脑内移植核心评估程序（CAPIT）方案对他们进行评估。其中3例患者还接受了定量运动测试，以测量上肢运动迟缓（运动时间；MT）。在右侧肾上腺切除术后，将由肾上腺髓质组织小碎片和切碎的肋间神经组成的联合移植物，在计算机断层扫描引导下立体定向植入右侧纹状体的三个靶点。手术顺利，术后磁共振成像显示移植物放置准确。未出现并发症。报告了术后24个月的临床和定量运动评估结果。术后“关”状态下的总统一帕金森病评定量表（UPDRS）运动评分从术前平均39.5分改善至术后3个月时的32.1分、6个月时的29.7分、9个月时的27.6分、12个月时的28.5分、18个月时的31.4分以及24个月时的26.5分。与基线相比，“关”状态下的总定时运动测试评分在术后6个月提高了17.9%、9个月提高了23.3%、12个月提高了18.2%、18个月提高了38.2%以及24个月提高了34.9%。在所有3例接受测试的患者中，左侧手臂（手术对侧）的运动时间显示出统计学上的显著改善（重复测量方差分析，P < 0.05）。这些结果表明，自体肾上腺髓质 - 周围神经联合移植物的立体定向纹状体内植入可以安全进行，并且该手术带来的临床改善可持续24个月。临床改善与客观的定量运动测试的改善相平行。
