英國一項最新研究發(fā)現(xiàn),，在帕金森氏癥的治療中,，如果在常規(guī)藥物治療外再加上在大腦中植入電極的手術(shù)療法，患者的震顫癥狀就可以得到更好地控制,，改善患者生活質(zhì)量,。
英國伯明翰大學(xué)等機構(gòu)研究人員在新一期《柳葉刀·神經(jīng)學(xué)》醫(yī)學(xué)期刊上報告說，300多名帕金森氏癥患者在過去幾年里參與了這項試驗,。他們被分為兩組,，其中一組只接受常規(guī)的藥物治療，而另一組還同時接受在大腦中植入電極的手術(shù)療法,。一年后的帕金森氏癥專用量表測試顯示,，前者癥狀改善只有0.3分，而后者癥狀改善程度達5分,。
帕金森氏癥是一種神經(jīng)系統(tǒng)變性疾病,，它會引起肌肉僵硬，以及手腳或身體其他部位的震顫,。由于手腳不由自主震顫,，許多帕金森氏癥患者日常生活不能自理。
目前帕金森氏癥的主要治療方法是藥物治療,，但近來醫(yī)學(xué)界研發(fā)出了“腦深度電刺激療法”,。這種療法是將若干電極的一端分別植入患者大腦中特定部位，這些電極的另一端連在一個植入皮下的類似心臟起搏器的小裝置上,。這個小裝置發(fā)出的電信號能夠阻斷大腦神經(jīng)系統(tǒng)病變部位發(fā)出的導(dǎo)致震顫的信號,，從而改善患者震顫癥狀。（生物谷Bioon.com）
生物谷推薦原文出處：
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.
