Volkmann J, Sturm V, Weiss P, Kappler J, Voges J, Koulousakis A, Lehrke R, Hefter H, Freund H J
Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany.
Ann Neurol. 1998 Dec;44(6):953-61. doi: 10.1002/ana.410440615.
We report here the results of an open prospective study in 9 patients suffering from severe Parkinson's disease with on/off fluctuations and restricted off-period mobility, who underwent bilateral implantation of stimulating electrodes in the internal pallidum. At 3-month follow-up, the total Unified Parkinson's Disease Rating Scale (UPDRS) motor score in the medication-off state was reduced from 54.1+/-14.8 to 23.9+/-11.7 (44.2%) when stimulation was turned on. Comparison of UPDRS subscores revealed significant improvements for tremor, rigidity, bradykinesia, gait and posture, and dyskinesias. The results of the clinical scoring could be confirmed by significant changes in the quantitative assessment of hand function and walking. Bilateral pallidal stimulation reduced the amount and severity of on/off fluctuations. Additional follow-up at 6 months (n=6), 9 months (n=6), and 12 months (n=4) did not show a decline in effectiveness of stimulation. There was no permanent morbidity associated with the procedure. A subtle reduction of verbal fluency, which was not evident to the patients, was the only cognitive side effect of the procedure in neuropsychological testing. Chronic bilateral high-frequency stimulation of the internal pallidum seems to be a neurologically safe and highly effective treatment for "off" symptoms, dyskinesias, and motor fluctuations in advanced stages of Parkinson's disease.
我们在此报告一项针对9例患有严重帕金森病且存在开/关波动及关期活动受限的患者的开放性前瞻性研究结果，这些患者接受了双侧苍白球内侧部刺激电极植入术。在3个月的随访中，开启刺激时，药物关期状态下的帕金森病统一评定量表（UPDRS）运动总分从54.1±14.8降至23.9±11.7（降低了44.2%）。UPDRS各分项评分比较显示，震颤、强直、运动迟缓、步态和姿势以及异动症均有显著改善。手部功能和步行的定量评估中的显著变化证实了临床评分结果。双侧苍白球刺激减少了开/关波动现象的次数和严重程度。在6个月（n = 6）、9个月（n = 6）和12个月（n = 4）的额外随访中，未显示刺激效果下降。该手术未产生永久性并发症。在神经心理学测试中，言语流畅性有轻微下降，但患者并未察觉，这是该手术唯一的认知方面副作用。慢性双侧高频刺激苍白球内侧部似乎是治疗帕金森病晚期“关”期症状、异动症和运动波动的一种神经学上安全且高效的治疗方法。
