https://scholars.lib.ntu.edu.tw/handle/123456789/513475
標題: | Subthalamotomy for advanced Parkinson disease | 作者: | Su P.C. Tseng H.-M. HON-MAN LIU RUOH-FANG YEN HORNG-HUEI LIOU |
公開日期: | 2002 | 卷: | 97 | 期: | 3 | 起(迄)頁: | 598-606 | 來源出版物: | Journal of Neurosurgery | 摘要: | Object. The aim of this study was to determine if subthalamotomy is effective in treating advanced Parkinson disease (PD). Methods. The authors performed microelectrode mapping-guided stereotactic surgery on the subthalamic nucleus in eight patients with PD. Lesioning was performed using radiofrequency heat coagulation and confirmed with magnetic resonance imaging. Three patients who underwent unilateral and four with bilateral subthalamotomy were evaluated for up to 18 months according to the Unified PD Rating Scale (UPDRS). One patient who underwent unilateral subthalamotomy died 6 months postsurgery. At 3 months into the "off" period after surgery, there were significant improvements in contralateral bradykinesia (p < 0.0002), rigidity (p < 0.0001), tremor (p < 0.01), axial motor features (p < 0.02), gait (p < 0.03), postural stability (p < 0.03), total UPDRS scores (p < 0.03), and Schwab and England scores (p < 0.04). The benefits were sustained at 6, 12, and 18 months, except for the improvement in tremor. At 12 months into the "on" period, significant benefits were present for motor fluctuation (p < 0.04), on dyskinesia (p < 0.006), off duration (p < 0.05), total UPDRS score (p < 0.02), and contralateral tremor (p < 0.05). Benefits for motor fluctuation, off duration, and off-period tremor were lost after the 18-month follow-up period. The levodopa requirement was reduced by 66% for the unilateral and 38% for the bilaterally treated group. Bilateral subthalamotomy offered more benefits than did unilateral surgery for various parkinsonian features in both the on and off periods. Three patients suffered hemiballismus, two recovered spontaneously, and one died of aspiration pneumonia after discontinuation of levodopa. Conclusions. These findings indicate that subthalamotomy can ameliorate the cardinal symptoms of PD, reduce the dosage, of levodopa, diminish complications of the drug therapy, and improve the quality of life. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/513475 | ISSN: | 0022-3085 | DOI: | 10.3171/jns.2002.97.3.0598 | SDG/關鍵字: | 1,2,3,6 tetrahydro 1 methyl 4 phenylpyridine; levodopa; adult; article; catheter ablation; clinical article; female; follow up; hemiballism; human; male; microelectrode; nuclear magnetic resonance imaging; Parkinson disease; postoperative complication; priority journal; quality of life; rating scale; stereotaxic surgery; subthalamic nucleus; thalamotomy |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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