帕金森病中单侧息切除术:一个随机的,单盲的,多中心的试验
R M de Bie1, R J de Haan, P C Nijssen
1Department of Neurology, Academic Medical Centre, University of Amsterdam, The Netherlands. r.m.debie@AMC.UVA.NL
Lancet (London, England)
|November 24, 1999
概括
单侧息切除术显著改善了晚期帕金森病患者的运动功能,并减少了对药物不反应的动力障碍. 这种手术干预为管理复杂的帕金森病症状提供了有前途的治疗选择.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 运动障碍 运动障碍
背景情况:
- 队列研究表明,单侧息切除术有益于晚期帕金森病 (PD) 患者.
- 单侧息切除术的有效性在随机,单盲,多中心试验中进行了评估.
- 患有晚期PD的患者经常经历衰弱的运动波动和动力障碍,尽管有最佳的医疗管理.
研究的目的:
- 为了评估单边息切除术在晚期帕金森病患者的疗效.
- 为了比较立即单边利切除术和延迟利切除术之间的结果.
- 评估息切除术对运动功能,运动障碍和残疾的影响.
主要方法:
- 一个随机的,单盲的多中心试验,涉及37名晚期帕金森病患者.
- 患者被分配到立即单边息切除术或延迟息切除术 (6个月后).
- 主要结局:在"关闭"状态下,统一帕金森病评分表 (UPDRS) 运动分数 (第三部分) 的变化. 二次结果:运动障碍评分表 (DRS) 和UPDRS第2部分分数.
主要成果:
- 在白切除组 (47至32.5) 中,中位数UPDRS 3"关闭"得分显著改善,而对照组 (52.5至56.5;p<0.001) 的情况恶化.
- 息切除术患者在DRS"上"得分中均有50%的改善,对照组没有变化.
- 在帕利多托米组的UPDRS 2"关闭"得分中,中位数改善了7分.
- 两名患者经历了严重的不良反应.
结论:
- 单侧息切除术是晚期帕金森病患者的有效治疗方法,这些患者对药物治疗的反应不足.
- 该程序在运动控制和减少勒沃多巴诱导的运动障碍方面显示出显著的益处.
- 帕利多托米为管理晚期帕金森病中耐火性症状提供了一个可行的治疗选择.
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