Levodopa Response after Unilateral Pallidotomy in Advanced Parkinson's Disease

진행된 파킨슨 환자에서 일측성 담창구파괴술 후 레보도파 치료효과 변화에 대한 연구

Background: Stereotactic pallidotomy is currently used for the symptomatic treatment of patients with advanced Parkinson's disease and motor complications related to drug treatment. However, these procedures are being performed in the absence of follow-up data on their retained effect and levodopa response after the surgery. The purpose of this study was to investigate the levodopa response after unilateral pallidotomy in advanced Parkinson's disease. Method : Clinical evaluation of levodopa responses were measured at baseline, 3, 6, 9, 12 months, and 2, 3, 4 years after surgery by means of the total levodopa equivalents. A set of rating scales(Hoehn and Yahr, Unified Parkinson's Disease Rating Scale, and Schwab and England) was also applied. Fifty patients who had had unilateral pallidotomy for advanced Parkinson's disease were investigated retrospectively. Results: The patient group consisted of 23 men and 27 women with a mean age of $58.6{\pm}11.3$ years. Mean disease duration was $7.22{\pm}4.28$ years. 29 pallidotomies were carried out on the left-and 21 on the right-brain hemisphere. Mean Hoehn and Yahr stage was $2.99{\pm}1.29$ while 'off' and $2.84{\pm}1.19$ while 'on' condition. Mean UPDRS score was $44.29{\pm}26.29$ while 'on' and $67.72{\pm}25.43$ while 'off' condition. The average total levodopa equivalent was 728.86 mg/day before the surgery, 611.12 mg/day after the surgery, and 694.7 mg/day at the last follow-up. After unilateral pallidotomy, there was no need to increase the levodopa dosage to control the symptoms in those patients who had previously required dosage increases to control the symptoms (p>0.05, 95%CI). Improvement was noted with UPDRS total score(39% while on state, 48% while off state) and Hoehn and Yahr stage(39% while on state, 42% while off state). Unilateral pallidotomy produced statistically significant improvement in symptoms for patients with advanced Parkinson' disease for whom medical therapy had failed(p<0.001, 95% Cl). Conclusion : After unilateral pallidotomy there were no statistically significant increase in the total dose of levodopa equivalents, and if needed, the patients were able to tolerate larger doses without experiencing adverse effects.