Evaluation of surgery for Parkinson's disease: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

Evaluation of surgery for Parkinson's disease: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

To the Editor: I write to comment on the report of the Task Force on Surgery for Parkinson’s Disease—particularly on the recommendations regarding bilateral deep brain stimulation of the subthalamic nucleus.1 I interpret “investigational” to mean that reasonable uncertainties exist. What is it about subthalamic nucleus stimulation that is uncertain? Reports from two major groups showed a highly significant reduction in parkinsonian symptoms. Assuming sound experimental design and appropriate statistical methods, is there any reasonable doubt that the subjects in these groups experienced symptom improvement? The answer is no. Most statistical tests are weighted against a type I error which is finding a difference when one does not truly exist. In one study,2 the changes in the Unified Parkinson Disease Rating Scales parts II and III were improved in the off-medication condition with a p < 0.001.2 Power …

致编辑：我写信是为了对帕金森病手术特别工作组的报告发表评论——特别是关于丘脑底核双侧深部脑刺激的相关建议。我将“研究性的”理解为存在合理的不确定性。丘脑底核刺激的哪些方面存在不确定性呢？两个主要研究小组的报告显示帕金森病症状有极显著的减轻。假设合理的实验设计和恰当的统计方法，对于这些小组中的受试者症状得到改善这一点是否存在合理的怀疑呢？答案是否定的。大多数统计检验都倾向于避免Ⅰ类错误，即当差异实际上不存在时却判定存在差异。在一项研究中，在未服药状态下，统一帕金森病评定量表第二部分和第三部分的变化有改善，P＜0.001。功效……