Pfann K D, Penn R D, Shannon K M, Corcos D M
School of Kinesiology, University of Illinois at Chicago, 60608-1516, USA.
Neurology. 1998 Sep;51(3):796-803. doi: 10.1212/wnl.51.3.796.
The scientific rationale for pallidotomy as a treatment for PD is that the lesion will reduce excessive tonic inhibition of the thalamus, thereby allowing movement to proceed more normally. If true, then PD patients who move slowly while on medication should increase movement speed following pallidotomy. To test this we used a simple motor task to determine if pallidotomy leads to an improvement in "on" motor performance when those movements are impaired before surgery.
Nine patients with PD performed elbow flexion movements "as fast as possible" while they were "on" before and 1 month after pallidotomy. Patients with mild PD and healthy control subjects were also tested.
The clinical effects of pallidotomy were typical of those found in other studies. "Off" Unified Parkinson's Disease Rating Scale scores improved and dyskinesias were reduced. Although before surgery the patients were far slower while they were "on" than the groups of mild PD patients and healthy control subjects, there was no change in mean peak velocity while they were "on" after pallidotomy. There was no change in other mean "on" motor performance measures such as peak acceleration, peak deceleration, initiation time, and symmetry. There was a decrease in the variability of peak acceleration, symmetry, and initiation time.
Despite the clinical efficacy of pallidotomy while patients were "off," bradykinesia of elbow flexion movements while patients were "on" is not affected by pallidotomy. Therefore, we conclude that the bradykinesia observed in this experiment is due to a mechanism other than excessive tonic inhibition of the motor thalamus. Our results are consistent with the idea that pallidotomy reduces the noise from the abnormally functioning basal ganglia.
苍白球切开术作为治疗帕金森病（PD）的科学依据是，该手术造成的损伤将减少丘脑过度的紧张性抑制，从而使运动能更正常地进行。如果这一理论正确，那么在服药期间行动缓慢的PD患者在接受苍白球切开术后应能提高运动速度。为验证这一点，我们采用一项简单的运动任务来确定苍白球切开术是否能改善术前运动功能受损的“开期”运动表现。
9例PD患者在接受苍白球切开术前及术后1个月“开期”时进行“尽可能快地”屈肘运动。同时对轻度PD患者和健康对照者也进行了测试。
苍白球切开术的临床效果与其他研究结果相似。“关期”统一帕金森病评定量表评分改善，异动症减少。虽然术前患者在“开期”时的运动速度远低于轻度PD患者组和健康对照组，但苍白球切开术后“开期”时的平均峰值速度并无变化。其他“开期”运动表现指标，如峰值加速度、峰值减速度、起始时间和对称性等也没有改变。峰值加速度、对称性和起始时间的变异性有所降低。
尽管苍白球切开术在患者“关期”具有临床疗效，但患者“开期”时的屈肘运动迟缓不受苍白球切开术影响。因此，我们得出结论，本实验中观察到的运动迟缓是由运动丘脑过度紧张性抑制以外的机制引起的。我们的结果与苍白球切开术减少功能异常的基底神经节产生的干扰这一观点一致。
