| Summary: | 碩士 === 高雄醫學大學 === 行為科學研究所 === 89 === Objective: Patient with Parkinson''s disease tend to responsed less well to long term levodopa treatment after several years of evololution of the disease. We evaluate the clinical aspects and results of pallidotomy and thalamotomy carried out as treatment for the major symptoms such as tremor, rigidity, bradykinesia, and postural instability and treatment induced complications such as drug-induced dyskinethia in patients with Parkinson''s disease (PD) because in Southern Taiwan it is unknow how far into the furture the surgical result will last. In this study that diagnosis of Parkinson''s disease was based on the clinical disgnostic criteria of the Unitied Kingdom Parkinson''s Disease Society Brain Bank.We wish to develop a new and refine stereotactic technique for accurate targeting of small parts of the brain.
Patients and Methods: Between November1999 and May 2001, 9 patients with PD were treated surgically, but we just studied 7patients,6women and 1 man participated in this study who had been diagnosed idiopathic Parkinson''s Diseaseand and followed up one year. The mean age was 62.86years, ages ranging from 45-81 years. The duration of the illness ranged from 13.1 years with a range of 9-21years. The cardinal symptoms of the series were bradykinesia, rigidity, tremor and drug-induce dyskinesia. 4 patients with unilateral PVP and 3 patients with pallidotomy and thalamotomy and microelectrode recording was not done.(The interval between two surgical serials are 4.6.2monthes). A pre- and post-surgical clinical evaluation was carried out with UPDRS, a widely accepted scale used in the evalution of new treatment of parkinson’s disease.All patients were assessed on UPDRS by the same assessor who was unaware of the patient’s symptoms. In this study we set up a baseline assessment before operation. All antiparkinsonian medications were held at midnight on the evering prior to the preoperative evaluation. The next morning a UPDRS (Unified Parkinson’s Disease Rating Scale)off-perood total scores were scored at baseline. Posoperative followed up evaluation occurred initially at 3 days,3.6 and 12 months.During the operative procedue, Leskell Stereotactic System (MHT, Freiburg, Germany) was used.At six monthes after the operation, the protocal also included a comprehensive neuropsychological assessment,the MMSE (Minimal Mental Status Examination).
Result:The symptoms of parkinson''s Disease vary widely and the prgnonosis for various symptom combination differs, it is important to consider the effectiveness of pallidotomy and thalamotomy in the differing types of Parkinson''s Disease so more experience and careful evaluation of the patients who obtain the procedures are needed. An up to date evaluation was carried out on all patients showing significant changes after pallidotomy and thalamotomy in UPDRS motor, complete rigidity relief, bradykinesia relief and complete tremor relief. An important improvement in contralateral dyskinesia was noted after pallidotomy. No significant correlation was found between age and duration of illness.In all patient the initial response is good but the valuable improvmentsof the symptom wane over week to months following surgery.About the postoperation complications as follow: Case 1 exhibited sever doorling, toung numbness and a euphoric status that seems to last one to two months. Case 2 had major depression and went to a psychiatric hospital and remained intermittently psychotic. Case 4 had a symptomatic lacunar hemorrage. Case 2 .3. 4 had an episode of depression during participating in the trial. Case 4.5.6 had hallucination and hypertalkative status. All cases did not develop transient or persistent dysarthria and confusion. The benefit of surgery are that levodopa- induced dyskinesia is dramatically reduced after pallidotomy, and another improvement is the relative benefit of medical therapy after surgery. We found no significant improvement in any off period symptoms after 6 month There were no significant post-operative changes in the use of medication.
Conclusion: The long-term effects and possible complications are unknown, and few data have been published and patient follow-up times have been insufficient. We have noted significant and unequivocal clinical benefit after surgery because Parkinson''s disease includes a varirty of symptoms that very greating between individual patients. Long-term result are related to what symptom of Parkinson''s Disease expression and also depened upon medication support but the hypothesis can''t be proved in our study. Pallidotomy is considered a safe and effective surgical method that provide benefit to L-dopa responsive Parkinson''s Disease patient dyskinesia, off-period rigidity, tremor, and bradykinesia. Thalamotomy provide benefit to tremor. Both of the surgical benefit just persisted about half year.
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