We conducted an open label pilot study of the effect of bilateral subthalamoto my in 18 patients with advanced Parkinson’s disease. In seven patients, the fir st subthalamotomy pre-dated the second by 12-24 months (...We conducted an open label pilot study of the effect of bilateral subthalamoto my in 18 patients with advanced Parkinson’s disease. In seven patients, the fir st subthalamotomy pre-dated the second by 12-24 months (‘staged surgery’). S ubsequently,a second group of 11 patients received bilateral subthalamotomy on t he same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a ba ttery of timed motor tests and neuropsychological tests. Evaluations were perfor med in the ‘off ’and ‘on’drug states before surgery and at 1 and 6 months an d every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.0 01) reduction in the ‘off’(49.5%) and ‘on’ (35.5%) Unified Parkinson’s Disease Rating Scale (UP- DRS) motor scores at the last assessment. A blind rating of videotapemotor exa ms in the ‘off’and ‘on’medication states preoperatively and at 2 years posto peratively also revealed a significant improvement. All of the cardinal features of Parkinson’s disease as well as activities of daily living (ADL) scores sign ificantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50 %(P < 0.01), and the mean daily levodopa dose was reduced by 47%at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred i ntraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized c horea that gradually resolved within the next 3-6 months.Three patients experie nced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dysk inesias.No patient exhibited permanent cognitive impairment. The motor benefit h as persisted for a follow-up of 3-6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanc ed Parkinson’s disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Fur ther refinement of the surgical procedure is mandatory.展开更多
文摘We conducted an open label pilot study of the effect of bilateral subthalamoto my in 18 patients with advanced Parkinson’s disease. In seven patients, the fir st subthalamotomy pre-dated the second by 12-24 months (‘staged surgery’). S ubsequently,a second group of 11 patients received bilateral subthalamotomy on t he same day (‘simultaneous surgery’). Patients were assessed according to the CAPIT (Core Assessment Program for Intracerebral Transplantation) protocol, a ba ttery of timed motor tests and neuropsychological tests. Evaluations were perfor med in the ‘off ’and ‘on’drug states before surgery and at 1 and 6 months an d every year thereafter for a minimum of 3 years after bilateral subthalamotomy. Compared with baseline, bilateral subthalamotomy induced a significant (P < 0.0 01) reduction in the ‘off’(49.5%) and ‘on’ (35.5%) Unified Parkinson’s Disease Rating Scale (UP- DRS) motor scores at the last assessment. A blind rating of videotapemotor exa ms in the ‘off’and ‘on’medication states preoperatively and at 2 years posto peratively also revealed a significant improvement. All of the cardinal features of Parkinson’s disease as well as activities of daily living (ADL) scores sign ificantly improved (P < 0.01). Levodopa-induced dyskinesias were reduced by 50 %(P < 0.01), and the mean daily levodopa dose was reduced by 47%at the time of the last evaluation compared with baseline (P < 0.0001). Dyskinesias occurred i ntraoperatively or in the immediate postoperative hours in 13 patients, but were generally mild and short lasting. Three patients developed severe generalized c horea that gradually resolved within the next 3-6 months.Three patients experie nced severe and persistent postoperative dysarthria. In two, this coincided with the patients exhibiting large bilateral lesions also suffering from severe dysk inesias.No patient exhibited permanent cognitive impairment. The motor benefit h as persisted for a follow-up of 3-6 years. This study indicates that bilateral subthalamotomy may induce a significant and long-lasting improvement of advanc ed Parkinson’s disease, but the clinical outcome was variable. This variability may depend in large part on the precise location and volume of the lesions. Fur ther refinement of the surgical procedure is mandatory.
