Scott R, Gregory R, Hines N, Carroll C, Hyman N, Papanasstasiou V, Leather C, Rowe J, Silburn P, Aziz T
Department of Neurological Surgery, Radcliffe Infirmary, Oxford, UK.
Brain. 1998 Apr;121 ( Pt 4):659-75. doi: 10.1093/brain/121.4.659.
Intellectual, psychological and functional outcomes were evaluated in a consecutive series of 20 Parkinsonian patients who had unilateral (UPVP) or simultaneous bilateral posteroventral pallidotomy (BPVP) using Image Fusion and Stereoplan (Radionics Inc., Boston, Mass., USA) with stimulation for lesion localization. Comprehensive baseline and 3-month postoperative neuropsychological and neurological assessment protocols were administered together with questionnaire measures of functional disability, quality of life and psychological symptomatology. Changes in patients' clinical presentation and scores on psychometric tests, questionnaires and observational rating scales were then examined. We observed no new neuropsychiatric sequelae directly related to pallidotomy. Cognitive sequelae were restricted to selective reductions in categorical verbal fluency following UPVP (P < 0.001) and BPVP (P < 0.01) and a reduction in phonemic verbal fluency following BPVP (P < 0.01); these changes were not reported subjectively. A fall in diadochokinetic rates (P < 0.01) and some subjective reports of a worsening in pre-existing dysarthria, hypophonia and hypersalivation/drooling following BPVP also suggested changes in speech motor apparatus; however, these changes did not have significant functional consequences. There was one case of more generalized cognitive impairment following BPVP. We also observed significant symptomatic improvement on neurological rating scales; following UPVP, Total Unified Parkinson's Disease Rating Scale (UPDRS) scores improved by 27% (P < 0.01) and following BPVP the improvement was 53% (P < 0.05). Patients' perceptions of reduced postoperative functional disability and improvements in 'quality of life' also achieved statistical significance on a number of both physical and psychosocial questionnaire subscales.
对连续的20例帕金森病患者进行了智力、心理和功能结局评估，这些患者接受了单侧（UPVP）或同期双侧后腹侧苍白球切开术（BPVP），采用图像融合和立体定向（美国马萨诸塞州波士顿的Radionics公司）并进行刺激以定位病灶。同时实施了全面的基线和术后3个月的神经心理学及神经学评估方案，以及功能残疾、生活质量和心理症状的问卷调查。然后检查了患者临床表现的变化以及心理测量测试、问卷和观察评分量表上的得分。我们未观察到与苍白球切开术直接相关的新的神经精神后遗症。认知后遗症仅限于UPVP（P < 0.001）和BPVP（P < 0.01）后分类言语流畅性的选择性降低以及BPVP后音素言语流畅性的降低（P < 0.01）；这些变化未被主观报告。BPVP后交替运动速率下降（P < 0.01）以及一些关于既往构音障碍、声音减弱和流涎增多/流口水加重的主观报告也提示言语运动器官发生了变化；然而，这些变化没有显著的功能后果。有1例BPVP后出现更广泛的认知障碍。我们还观察到神经学评分量表上有显著的症状改善；UPVP后，帕金森病统一评分量表（UPDRS）总分提高了27%（P < 0.01）。BPVP后改善为53%（P < 0.05）。患者对术后功能残疾减轻和“生活质量”改善的认知在一些身体和心理社会问卷子量表上也具有统计学意义。
