英国一项最新研究发现，在帕金森氏症的治疗中，如果在常规药物治疗外再加上在大脑中植入电极的手术疗法，患者的震颤症状就可以得到更好地控制，改善患者生活质量。
英国伯明翰大学等机构研究人员在新一期《柳叶刀·神经学》医学期刊上报告说，300多名帕金森氏症患者在过去几年里参与了这项试验。他们被分为两组，其中一组只接受常规的药物治疗，而另一组还同时接受在大脑中植入电极的手术疗法。一年后的帕金森氏症专用量表测试显示，前者症状改善只有0.3分，而后者症状改善程度达5分。
帕金森氏症是一种神经系统变性疾病，它会引起肌肉僵硬，以及手脚或身体其他部位的震颤。由于手脚不由自主震颤，许多帕金森氏症患者日常生活不能自理。
目前帕金森氏症的主要治疗方法是药物治疗，但近来医学界研发出了“脑深度电刺激疗法”。这种疗法是将若干电极的一端分别植入患者大脑中特定部位，这些电极的另一端连在一个植入皮下的类似心脏起搏器的小装置上。这个小装置发出的电信号能够阻断大脑神经系统病变部位发出的导致震颤的信号，从而改善患者震颤症状。（生物谷Bioon.com）
生物谷推荐原文出处：
The Lancet Neurology doi:10.1016/S1474-4422(10)70093-4
Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trial
Prof Adrian Williams MD a *, Prof Steven Gill FRCS b, Thelekat Varma FRCS[Ed] c, Prof Crispin Jenkinson DPhil d, Prof Niall Quinn MD e, Rosalind Mitchell FRCS a, Richard Scott PhD f, Natalie Ives MSc g , Caroline Rick PhD g, Jane Daniels MSc g, Smitaa Patel MSc g, Prof Keith Wheatley DPhil g *, on behalf of the PD SURG Collaborative Group
Background
Surgical intervention for advanced Parkinson's disease is an option if medical therapy fails to control symptoms adequately. We aimed to assess whether surgery and best medical therapy improved self-reported quality of life more than best medical therapy alone in patients with advanced Parkinson's disease.
Methods
The PD SURG trial is an ongoing randomised, open-label trial. At 13 neurosurgical centres in the UK, between November, 2000, and December, 2006, patients with Parkinson's disease that was not adequately controlled by medical therapy were randomly assigned by use of a computerised minimisation procedure to immediate surgery (lesioning or deep brain stimulation at the discretion of the local clinician) and best medical therapy or to best medical therapy alone. Patients were analysed in the treatment group to which they were randomised, irrespective of whether they received their allocated treatment. The primary endpoint was patient self-reported quality of life on the 39-item Parkinson's disease questionnaire (PDQ-39). Changes between baseline and 1 year were compared by use of t tests. This trial is registered with Current Controlled Trials, number ISRCTN34111222.
Findings
366 patients were randomly assigned to receive immediate surgery and best medical therapy (183) or best medical therapy alone (183). All patients who had surgery had deep brain stimulation. At 1 year, the mean improvement in PDQ-39 summary index score compared with baseline was 5·0 points in the surgery group and 0·3 points in the medical therapy group (difference ?4·7, 95% CI ?7·6 to ?1·8; p=0·001); the difference in mean change in PDQ-39 score in the mobility domain between the surgery group and the best medical therapy group was ?8·9 (95% CI ?13·8 to ?4·0; p=0·0004), in the activities of daily living domain was ?12·4 (?17·3 to ?7·5; p<0·0001), and in the bodily discomfort domain was ?7·5 (?12·6 to ?2·4; p=0·004). Differences between groups in all other domains of the PDQ-39 were not significant. 36 (19%) patients had serious surgery-related adverse events; there were no suicides but there was one procedure-related death. 20 patients in the surgery group and 13 in the best medical therapy group had serious adverse events related to Parkinson's disease and drug treatment.
Interpretation
At 1 year, surgery and best medical therapy improved patient self-reported quality of life more than best medical therapy alone in patients with advanced Parkinson's disease. These differences are clinically meaningful, but surgery is not without risk and targeting of patients most likely to benefit might be warranted.
Funding
UK Medical Research Council, Parkinson's UK, and UK Department of Health.
