Trépanier L L, Saint-Cyr J A, Lozano A M, Lang A E
Department of Psychology, The Toronto Hospital, and York University, Ontario, Canada.
Neurology. 1998 Jul;51(1):207-15. doi: 10.1212/wnl.51.1.207.
Neuropsychological changes were assessed in patients who had idiopathic PD after unilateral posteroventral pallidotomy.
Posteroventral stereotactic pallidotomies were performed on 42 PD patients (24 right and 18 left hemisphere). All patients were evaluated in the "on state" before the procedure (n = 42) and at intervals of 3 (n = 26), 6 (n = 27), and 12+ (n = 24) months after surgery.
Modest improvement in sustained attention and decline in working memory was observed by 6 months after surgery. Left hemisphere lesions led to a loss of verbal learning (-2.2 SD) and verbal fluency (-1.6 SD) in 60% of patients at their first evaluation at 3 or 6 months. No patients returned to baseline on the verbal fluency task and most (71%) did not recover verbal-learning ability by 12 months after surgery. Right hemisphere lesions led to a loss of visuospatial constructional abilities (-3.5 SD), which fully resolved by 12 months for all but one patient. Evidence of further decline of frontal-executive functioning was noted within other tasks but not on a "direct" test (i.e., Conditional Associative Learning). Lastly, behavioral changes of a "frontal nature" were reported in 25% to 30% of patients. These cognitive and emotional costs increased dependence in these domains and negatively affected some patients' relations with caregivers and restricted their ability to function properly at work or in social settings. Caregivers, particularly, and patients who were aware of their resulting changes had difficulty adjusting after surgery.
Although patients and caregivers were generally pleased with the clinical neurologic outcome of the procedure, the neurologic benefits of unilateral pallidotomy must be weighed against modest cognitive and behavioral risks.
评估接受单侧后腹侧苍白球切开术的特发性帕金森病患者的神经心理学变化。
对42例帕金森病患者（24例右侧半球和18例左侧半球）进行后腹侧立体定向苍白球切开术。所有患者在手术前（n = 42）处于“开期”时进行评估，并在术后3个月（n = 26）、6个月（n = 27）和12个月以上（n = 24）时进行评估。
术后6个月观察到持续注意力有适度改善，工作记忆下降。左侧半球病变导致60%的患者在术后3或6个月首次评估时出现言语学习能力丧失（-2.2标准差）和言语流畅性丧失（-1.6标准差）。没有患者在言语流畅性任务上恢复到基线水平，大多数患者（71%）在术后12个月时未恢复言语学习能力。右侧半球病变导致视觉空间构建能力丧失（-3.5标准差），除1例患者外，所有患者在12个月时完全恢复。在其他任务中发现额叶执行功能进一步下降的证据，但在“直接”测试（即条件联想学习）中未发现。最后，25%至30%的患者报告有“额叶性质”的行为变化。这些认知和情感代价增加了这些领域的依赖性，并对一些患者与照顾者的关系产生负面影响，限制了他们在工作或社交场合正常发挥功能的能力。特别是照顾者以及意识到自身变化结果的患者在术后难以适应。
尽管患者和照顾者通常对该手术的临床神经学结果感到满意，但单侧苍白球切开术的神经学益处必须与适度的认知和行为风险相权衡。
