科研之友
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摘要
Objective: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been reported to be effective in alleviating all parkinsonian motor symptoms and motor complications in moderate-to-advanced Parkinson's disease (PD). We have studied the effects of unilateral STN lesions on moderate-to-advanced PD. Methods: Eleven patients (eight male, three female) with moderate-to-advanced PD were studied. Before surgery, all patients suffered from one or more motor complications (wearing-off and on-off phenomena, dyskinesias). All patients had Hoehn and Yahr stage 3 or 4 in off-drug condition and were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS). The follow-up time ranged between 12 and 20 months (mean: 14 +/- 2.94 months). STN was identified through CT and MRI scans. STN lesions were performed unilaterally using thermocoagulation. Results: Subthalamotomy induced a marked motor improvement contralaterally, ipsilaterally and axially. Mean "on" time total UPDRS and motor scores decreased from 61.7 +/- 19.2 to 31.6 +/- 15.7 (p=0.001) and from 26.1 +/- 11.1 to 15 +/- 11.1 (p=0.02), respectively. Total 'on' time period increased by 50% in eight patients but did not change in the remaining three. Nine patients had disabling dyskinesia and six of these patients improved significantly (mean 40%, UPDRS part IV). Compared to pre-surgical doses, the levodopa-equivalent dose was reduced in eight patients, increased in one and left unchanged in the remaining two patients during the postoperative phase. Notably, only one out of eleven patients developed hemiballismus. Hemiballistic movements emerged immediately after the ablation and were ameliorated under treatment within two weeks after surgery. Conclusion: We conclude that subthalamotomy is a safe and effective treatment for moderate-to-advanced PD. In cases in which DBS is not feasible, subthalamotomy may be considered as an alternative procedure. (Archives of Neuropsychiatry 2011; 48: 114-8)
- 出版日期2011
