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1.
World Neurosurg ; 155: e19-e33, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34325026

RESUMEN

BACKGROUND: Intermittent explosive disorder (IED) is a psychiatric disorder characterized by recurrent outbursts of aggressive behavior. Deep brain stimulation (DBS) in the posteromedial nucleus of the hypothalamus (pHyp) is an alternative therapy for extreme cases and shows promising results. Intraoperative microdialysis can help elucidate the neurobiological mechanism of pHyp-DBS. We sought to evaluate efficacy and safety of pHyp-DBS using 8-contact directional leads in patients with refractory IED (rIED) and the accompanying changes in neurotransmitters. METHODS: This was a prospective study in which patients with a diagnosis of rIED were treated with pHyp-DBS for symptom alleviation. Bilateral pHyp-DBS was performed with 8-contact directional electrodes. Follow-up was performed at 3, 6, and 12 months after surgery. RESULTS: Four patients (3 men, mean age 27 ± 2.8 years) were included. All patients were diagnosed with rIED and severe intellectual disability. Two patients had congenital rubella, one had a co-diagnosis of infantile autism, and the fourth presented with drug-resistant epilepsy. There was a marked increase in the levels of gamma-aminobutyric acid and glycine during intraoperative stimulation. The average improvement in aggressive behavior in the last follow-up was 6 points (Δ: 50%, P = 0.003) while also documenting an important improvement of the Short Form Health Survey in all domains except bodily pain. No adverse events associated with pHyp-DBS were observed. CONCLUSIONS: This is the first study to show the safety and beneficial effect of directional lead pHyp-DBS in patients with rIED and to demonstrate the corresponding mechanism of action through increases in gamma-aminobutyric acid and glycine concentration in the pHyp.


Asunto(s)
Estimulación Encefálica Profunda , Trastornos Disruptivos, del Control de Impulso y de la Conducta/cirugía , Hipotálamo/cirugía , Adulto , Femenino , Humanos , Hipotálamo/fisiopatología , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven
2.
Mov Disord ; 34(3): 353-365, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30719763

RESUMEN

OBJECTIVE: Real-life observational report of clinical efficacy of bilateral subthalamic stimulation (STN-DBS), apomorphine (APO), and intrajejunal levodopa infusion (IJLI) on quality of life, motor, and nonmotor symptoms (NMS) in Parkinson's disease (PD). METHODS: In this prospective, multicenter, international, real-life cohort observation study of 173 PD patients undergoing STN-DBS (n = 101), IJLI (n = 33), or APO (n = 39) were followed-up using PDQuestionnaire-8, NMSScale (NMSS), Unified PD Rating Scale (UPDRS)-III, UPDRS-IV, and levodopa equivalent daily dose (LEDD) before and 6 months after intervention. Outcome changes were analyzed with Wilcoxon signed-rank or paired t test when parametric tests were applicable. Multiple comparisons were corrected (multiple treatments/scales). Effect strengths were quantified with relative changes, effect size, and number needed to treat. Analyses were computed before and after propensity score matching, balancing demographic and clinical characteristics. RESULTS: In all groups, PDQuestionnaire-8, UPDRS-IV, and NMSS total scores improved significantly at follow-up. Levodopa equivalent daily dose was significantly reduced after STN-DBS. Explorative NMSS domain analyses resulted in distinct profiles: STN-DBS improved urinary/sexual functions, mood/cognition, sleep/fatigue, and the miscellaneous domain. IJLI improved the 3 latter domains and gastrointestinal symptoms. APO improved mood/cognition, perceptual problems/hallucinations, attention/memory, and the miscellaneous domain. Overall, STN-DBS and IJLI seemed favorable for NMSS total score, and APO favorable for neuropsychological/neuropsychiatric NMS and PDQuestionnaire-8 outcome. CONCLUSIONS: This is the first comparison of quality of life, nonmotor. and motor outcomes in PD patients undergoing STN-DBS, IJLI, and APO in a real-life cohort. Distinct effect profiles were identified for each treatment option. Our results highlight the importance of holistic nonmotor and motor symptoms assessments to personalize treatment choices. © 2019 International Parkinson and Movement Disorder Society.


Asunto(s)
Antiparkinsonianos/uso terapéutico , Apomorfina/uso terapéutico , Estimulación Encefálica Profunda/métodos , Agonistas de Dopamina/uso terapéutico , Levodopa/uso terapéutico , Enfermedad de Parkinson/terapia , Núcleo Subtalámico/fisiopatología , Anciano , Femenino , Humanos , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/fisiopatología , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento
3.
Neurosurgery ; 85(1): 11-30, 2019 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-30690521

RESUMEN

Aggressiveness has a high prevalence in psychiatric patients and is a major health problem. Two brain areas involved in the neural network of aggressive behavior are the amygdala and the hypothalamus. While pharmacological treatments are effective in most patients, some do not properly respond to conventional therapies and are considered medically refractory. In this population, surgical procedures (ie, stereotactic lesions and deep brain stimulation) have been performed in an attempt to improve symptomatology and quality of life. Clinical results obtained after surgery are difficult to interpret, and the mechanisms responsible for postoperative reductions in aggressive behavior are unknown. We review the rationale and neurobiological characteristics that may help to explain why functional neurosurgery has been proposed to control aggressive behavior.


Asunto(s)
Agresión/fisiología , Amígdala del Cerebelo/fisiopatología , Hipotálamo/fisiopatología , Amígdala del Cerebelo/cirugía , Humanos , Hipotálamo/cirugía , Procedimientos Neuroquirúrgicos/métodos
4.
Neuromodulation ; 21(3): 310-316, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29082637

RESUMEN

OBJECTIVE: Leprosy affects approximately 10-15 million patients worldwide and remains a relevant public health issue. Chronic pain secondary to leprosy is a primary cause of morbidity, and its treatment remains a challenge. We evaluated the feasibility and safety of peripheral nerve stimulation (PNS) for painful mononeuropathy secondary to leprosy that is refractory to pharmacological therapy and surgical intervention (decompression). METHODS: Between 2011 and 2013 twenty-three patients with painful mononeuropathy secondary to leprosy were recruited to this prospective case series. All patients were considered to be refractory to optimized conservative treatment and neurosurgical decompression. Pain was evaluated over the course of the study using the neuropathic pain scale and the visual analog scale for pain. In the first stage, patients were implanted with a temporary electrode that was connected to an external stimulator, and were treated with PNS for seven days. Patients with 50% or greater pain relief received a definitive implantation in the second stage. Follow-ups in the second stage were conducted at 1, 3, 6, and 12 months. RESULTS: After seven days of trial in the first stage, 10 patients showed a pain reduction of 50% or greater. At 12-month follow-up in the second stage, 6 of the 10 patients who underwent permanent device implantation showed a pain reduction of 50% or greater (75% reduction on average), and two patients showed a 30% reduction in pain. Two patients presented with electrode migration that required repositioning during the 12-month follow-up period. CONCLUSIONS: Our data suggest that PNS might have significant long-term utility for the treatment of painful mononeuropathy secondary to leprosy. Future studies should be performed in order to corroborate our findings in a larger population and encourage the clinical implementation of this technique.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Lepra/complicaciones , Mononeuropatías/etiología , Neuralgia/terapia , Manejo del Dolor/métodos , Dolor Crónico/etiología , Dolor Crónico/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neuralgia/etiología , Resultado del Tratamiento
5.
Rev Assoc Med Bras (1992) ; 63(4): 355-360, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28614539

RESUMEN

INTRODUCTION:: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. OBJECTIVE:: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. METHOD:: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. RESULTS:: The patients showed significant pain relief, but no improvement was observed in the functional scales. CONCLUSION:: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.


Asunto(s)
Analgésicos/uso terapéutico , Evaluación de la Discapacidad , Síndrome de Fracaso de la Cirugía Espinal Lumbar/tratamiento farmacológico , Dolor de la Región Lumbar/tratamiento farmacológico , Ozono/uso terapéutico , Adulto , Anciano , Análisis de Varianza , Síndrome de Fracaso de la Cirugía Espinal Lumbar/fisiopatología , Femenino , Humanos , Inyecciones Epidurales , Dolor de la Región Lumbar/fisiopatología , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Reproducibilidad de los Resultados , Estudios Retrospectivos , Perfil de Impacto de Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
6.
Rev. Assoc. Med. Bras. (1992, Impr.) ; Rev. Assoc. Med. Bras. (1992, Impr.);63(4): 355-360, Apr. 2017. tab, graf
Artículo en Inglés | LILACS | ID: biblio-842550

RESUMEN

Summary Introduction: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. Objective: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. Method: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. Results: The patients showed significant pain relief, but no improvement was observed in the functional scales. Conclusion: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.


Resumo Introdução: A dor lombar é um dos distúrbios dolorosos de maior prevalência. Tem diversas etiologias e, na presença de déficits neurológicos ou síndromes compressivas, pode ser indicada cirurgia. Entretanto, em até 40% dos casos os pacientes podem evoluir com piora da dor e síndrome dolorosa pós-laminectomia (SDPL), que se constitui em uma importante causa de dor crônica com grande morbidade e incapacidade. Nas últimas duas décadas, o ozônio tem se mostrado uma nova opção terapêutica para a SDPL em virtude das suas propriedades analgésicas e anti-inflamatórias. Objetivo: Avaliar o efeito da ozonioterapia na dor e na incapacidade de pacientes com SDPL. Método: Foram selecionados 19 pacientes, submetidos a epiduroscopia e aplicação de ozônio. Os pacientes foram avaliados no pré-operatório e 21 dias após o procedimento, por meio de Escala Visual Analógica, Inventário Breve de Dor, Questionário Roland-Morris de Incapacidade, Oswestry Disability Scale, Inventário de Sintomas de Dor Neuropática e Questionário de Dor Neuropática. Resultados: Os pacientes apresentaram redução significante nos escores das escalas de avaliação de dor; porém, essa redução não foi observada na avaliação da incapacidade funcional. Conclusão: Os dados obtidos sugerem que a ozonioterapia epidural pode ser uma opção de manejo da SDPL na diminuição da intensidade da dor.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Adulto Joven , Ozono/uso terapéutico , Dolor de la Región Lumbar/tratamiento farmacológico , Evaluación de la Discapacidad , Síndrome de Fracaso de la Cirugía Espinal Lumbar/tratamiento farmacológico , Analgésicos/uso terapéutico , Factores de Tiempo , Inyecciones Epidurales , Dimensión del Dolor , Encuestas y Cuestionarios , Reproducibilidad de los Resultados , Estudios Retrospectivos , Análisis de Varianza , Resultado del Tratamiento , Dolor de la Región Lumbar/fisiopatología , Perfil de Impacto de Enfermedad , Síndrome de Fracaso de la Cirugía Espinal Lumbar/fisiopatología , Persona de Mediana Edad
7.
Hum Mov Sci ; 37: 147-56, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25215623

RESUMEN

Evidence supports the use of rhythmic external auditory signals to improve gait in PD patients (Arias & Cudeiro, 2008; Kenyon & Thaut, 2000; McIntosh, Rice & Thaut, 1994; McIntosh et al., 1997; Morris, Iansek, & Matyas, 1994; Thaut, McIntosh, & Rice, 1997; Suteerawattananon, Morris, Etnyre, Jankovic, & Protas , 2004; Willems, Nieuwboer, Chavert, & Desloovere, 2006). However, few prototypes are available for daily use, and to our knowledge, none utilize a smartphone application allowing individualized sounds and cadence. Therefore, we analyzed the effects on gait of Listenmee®, an intelligent glasses system with a portable auditory device, and present its smartphone application, the Listenmee app®, offering over 100 different sounds and an adjustable metronome to individualize the cueing rate as well as its smartwatch with accelerometer to detect magnitude and direction of the proper acceleration, track calorie count, sleep patterns, steps count and daily distances. The present study included patients with idiopathic PD presented gait disturbances including freezing. Auditory rhythmic cues were delivered through Listenmee®. Performance was analyzed in a motion and gait analysis laboratory. The results revealed significant improvements in gait performance over three major dependent variables: walking speed in 38.1%, cadence in 28.1% and stride length in 44.5%. Our findings suggest that auditory cueing through Listenmee® may significantly enhance gait performance. Further studies are needed to elucidate the potential role and maximize the benefits of these portable devices.


Asunto(s)
Estimulación Acústica/métodos , Teléfono Celular , Marcha , Aplicaciones Móviles , Enfermedad de Parkinson/fisiopatología , Desempeño Psicomotor/fisiología , Aceleración , Anciano , Señales (Psicología) , Diseño de Equipo , Anteojos , Femenino , Trastornos Neurológicos de la Marcha/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Caminata
8.
Rev Assoc Med Bras (1992) ; 57(3): 282-7, 2011.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-21691691

RESUMEN

OBJECTIVE: The authors show the clinical evaluation and follow-up results in 56 patients diagnosed with a failed back surgery pain syndrome. METHODS: Descriptive and prospective study conducted over a one-year period. In this study, 56 patients with a failed back surgery pain syndrome were assessed in our facility. The age ranged from 28 to 76 years (mean, 48.8 ± 13.9 years). The pain was assessed through a Visual Analog Scale (VAS). RESULTS: Postoperative pain was more severe (mean VAS score 8.3) than preoperative pain (7.2). Myofascial pain syndromes (MPS) were diagnosed in 85.7% of patients; neuropathic abnormalities associated or not with MPS were found in 73.3%. Drug therapy associated with physical medicine treatment provided > 50% pain improvement in 57.2% of cases; trigger point injection in 60.1%, and epidural infusion of morphine with lidocaína in 69.3% of refractory cases. CONCLUSION: In patients with a post-laminectomy syndrome, postoperative pain was more severe than preoperative pain from a herniated disk. A miofascial component was found in most patients.


Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/terapia , Síndromes del Dolor Miofascial/terapia , Dolor Postoperatorio/terapia , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Síndrome de Fracaso de la Cirugía Espinal Lumbar/fisiopatología , Femenino , Humanos , Lidocaína/uso terapéutico , Masculino , Persona de Mediana Edad , Morfina/uso terapéutico , Síndromes del Dolor Miofascial/fisiopatología , Dimensión del Dolor , Dolor Postoperatorio/fisiopatología , Estudios Prospectivos
9.
Rev. Assoc. Med. Bras. (1992, Impr.) ; Rev. Assoc. Med. Bras. (1992, Impr.);57(3): 286-291, May-June 2011. tab
Artículo en Portugués | LILACS | ID: lil-591355

RESUMEN

OBJETIVO: Os autores apresentam os resultados da avaliação clínica e acompanhamento de 56 pacientes com diagnóstico de síndrome dolorosa pós-laminectomia lombar. MÉTODOS: Estudo descritivo, prospectivo realizado no período de um ano. Neste estudo foram avaliados 56 pacientes caracterizados com síndrome dolorosa pós-laminectomia lombar em nossa instituição. As idades variaram de 28 a 76 anos (média de 48,8 ± 13,9 anos). Avaliação da dor com Escala Visual e Analógica (EVA). RESULTADOS: A dor pós-operatória foi mais intensa (8,3, média de EVA) que a pré-operatória (7,2). Síndrome dolorosa miofascial (SDM) foi diagnosticada em 85,7 por cento dos pacientes, anormalidades neuropáticas associadas ou não à SDM em 73,3 por cento. O tratamento farmacológico associado à medicina física proporcionou melhora de mais de 50 por cento da dor em 57,2 por cento dos casos, a infiltração dos pontos-gatilho miofasciais em 60,1 por cento e a infusão de morfina com lidocaína no compartimento epidural lombar em 69,3 por cento dos casos refratários. CONCLUSÃO: Nos pacientes com síndrome pós-laminectomia, a dor pós-operatória foi mais intensa que a dor pré-operatória da hérnia de disco. Um componente miofascial foi verificado na maioria dos doentes.


OBJECTIVE: The authors show the clinical evaluation and follow-up results in 56 patients diagnosed with a failed back surgery pain syndrome. METHODS: Descriptive and prospective study conducted over a one-year period. In this study, 56 patients with a failed back surgery pain syndrome were assessed in our facility. The age ranged from 28 to 76 years (mean, 48.8 ± 13.9 years). The pain was assessed through a Visual Analog Scale (VAS). RESULTS: Postoperative pain was more severe (mean VAS score 8.3) than preoperative pain (7.2). Myofascial pain syndromes (MPS) were diagnosed in 85.7 percent of patients; neuropathic abnormalities associated or not with MPS were found in 73.3 percent. Drug therapy associated with physical medicine treatment provided > 50 percent pain improvement in 57.2 percent of cases; trigger point injection in 60.1 percent, and epidural infusion of morphine with lidocaína in 69.3 percent of refractory cases. CONCLUSION: In patients with a post-laminectomy syndrome, postoperative pain was more severe than preoperative pain from a herniated disk. A miofascial component was found in most patients.


Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Fracaso de la Cirugía Espinal Lumbar/terapia , Síndromes del Dolor Miofascial/terapia , Dolor Postoperatorio/terapia , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Síndrome de Fracaso de la Cirugía Espinal Lumbar/fisiopatología , Lidocaína/uso terapéutico , Morfina/uso terapéutico , Síndromes del Dolor Miofascial/fisiopatología , Dimensión del Dolor , Dolor Postoperatorio/fisiopatología , Estudios Prospectivos
10.
Stereotact Funct Neurosurg ; 89(3): 167-72, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21494069

RESUMEN

In addition to pain and neurovegetative symptoms, patients with severe forms of complex regional pain syndrome (CRPS) develop a broad range of symptoms, including sensory disturbances, motor impairment and dystonic posturing. While most patients respond to medical therapy, some are considered refractory and become surgical candidates. To date, the most commonly used surgical procedure for CRPS has been spinal cord stimulation. This therapy often leads to important analgesic effects, but no sensory or motor improvements. We report on 2 patients with pain related to CRPS and severe functional deficits treated with motor cortex stimulation (MCS) who not only had significant analgesic effects, but also improvements in sensory and motor symptoms. In the long term (27 and 36 months after surgery), visual analog scale pain scores were improved by 60-70% as compared to baseline. There was also a significant increase in the range of motion in the joints of the affected limbs and an improvement in allodynia, hyperpathia and hypoesthesia. Positron emission tomography scan in both subjects revealed that MCS influenced regions involved in the circuitry of pain.


Asunto(s)
Síndromes de Dolor Regional Complejo/terapia , Terapia por Estimulación Eléctrica/métodos , Corteza Motora/cirugía , Adulto , Síndromes de Dolor Regional Complejo/fisiopatología , Humanos , Masculino , Corteza Motora/fisiopatología , Dimensión del Dolor , Recuperación de la Función , Resultado del Tratamiento
13.
Arq Neuropsiquiatr ; 66(3A): 534-8, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18813714

RESUMEN

OBJECTIVE: The main objective when resecting benign brain lesions is to minimize risk of postoperative neurological deficits. We have assessed the safety and effectiveness of craniotomy under local anesthesia and monitored conscious sedation for the resection of lesions involving eloquent language cortex. METHODS: A retrospective review was performed on a consecutive series of 12 patients who underwent craniotomy under local anesthesia between 2001 and 2004. All patients had lesions close to the speech cortex. All resection was verified by post-operative imaging. Six subjects were male and 6 female, and were aged between 14 and 52 years. RESULTS: Lesions comprised 7 tumour lesions, 3 cavernomas and 1 dermoid cyst. Radiological gross total resection was achieved in 66% of patients while remaining cases had greater than 80% resection. Only one patient had a post-operative permanent deficit, whilst another had a transient post-operative deficit. All patients with uncontrollable epilepsy had good outcomes after surgery. None of our cases subsequently needed to be put under general anesthesia. CONCLUSION: Awake craniotomy with brain mapping is a safe technique and the "gold standard" for resection of lesions involving language areas.


Asunto(s)
Mapeo Encefálico/métodos , Neoplasias Encefálicas/cirugía , Corteza Cerebral/cirugía , Sedación Consciente/métodos , Craneotomía/métodos , Adolescente , Adulto , Anestesia Local , Anestésicos Locales/administración & dosificación , Corteza Cerebral/anatomía & histología , Corteza Cerebral/fisiología , Estimulación Eléctrica , Femenino , Humanos , Trastornos del Lenguaje/prevención & control , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Habla/fisiología , Adulto Joven
14.
Arq. neuropsiquiatr ; Arq. neuropsiquiatr;66(3a): 534-538, set. 2008. ilus, tab
Artículo en Inglés | LILACS | ID: lil-492576

RESUMEN

OBJECTIVE: The main objective when resecting benign brain lesions is to minimize risk of postoperative neurological deficits. We have assessed the safety and effectiveness of craniotomy under local anesthesia and monitored conscious sedation for the resection of lesions involving eloquent language cortex. METHODS: A retrospective review was performed on a consecutive series of 12 patients who underwent craniotomy under local anesthesia between 2001 and 2004. All patients had lesions close to the speech cortex. All resection was verified by post-operative imaging. Six subjects were male and 6 female, and were aged between 14 and 52 years. RESULTS: Lesions comprised 7 tumour lesions, 3 cavernomas and 1 dermoid cyst. Radiological gross total resection was achieved in 66 percent of patients while remaining cases had greater than 80 percent resection. Only one patient had a post-operative permanent deficit, whilst another had a transient post-operative deficit. All patients with uncontrollable epilepsy had good outcomes after surgery. None of our cases subsequently needed to be put under general anesthesia. CONCLUSION: Awake craniotomy with brain mapping is a safe technique and the "gold standard" for resection of lesions involving language areas.


OBJETIVO: O presente estudo visa discutir as vantagens e as limitacões do uso da técnica de mapeamento cortical da área da fala com o paciente acordado. MÉTODO: esta é uma revisão retrospectiva dos casos em que foi realizado monitoramento cortical intraoperatório em cirurgias para ressecção de lesões intracranianas localizadas próximas à área da fala. Todos os pacientes foram submetidos a avaliação neuropsicológica no pré e intra-operatório. O grau das ressecções foi verificado através de exames de imagem pós-operatórios. Foram avaliados um total de 12 pacientes. Destes, 6 eram do sexo masculino e 6 do feminino. RESULTADOS: 7 lesões eram tumorais. A ressecção total foi atingida em 66 por cento e ressecção subtotal nos remanescentes. Apenas 1 paciente apresentou déficit motor permanente no pós-operatório e todos os pacientes com quadro prévio de epilepsia refratária obtiveram bom controle das crises no pós-operatório. Em nenhum caso houve necessidade de conversão da anestesia para geral. CONCLUSÃO: O mapeamento funcional intraoperatório na craniotomia com o paciente acordado otimiza a extensão da ressecção da lesão minimizando morbidade permanente. Esta é uma técnica eficaz no manejo de lesões em íntimo contato com o córtex eloqüente, que outrora, seriam designadas inoperáveis.


Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Mapeo Encefálico/métodos , Neoplasias Encefálicas/cirugía , Corteza Cerebral/cirugía , Sedación Consciente/métodos , Craneotomía/métodos , Anestesia Local , Anestésicos Locales/administración & dosificación , Corteza Cerebral/anatomía & histología , Corteza Cerebral/fisiología , Estimulación Eléctrica , Trastornos del Lenguaje/prevención & control , Monitoreo Intraoperatorio , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Habla/fisiología , Adulto Joven
15.
São Paulo; s.n; 2007. [158] p. ilus, graf, tab.
Tesis en Portugués | LILACS | ID: lil-505548

RESUMEN

Introdução. Nos últimos a função motora vem sendo associada com a atenuação sensitiva e de dor, logo antes, durante e apos a contração muscular. No entanto as vias anatômicas e funcionais deste fenômeno não são conhecidas. O objetivo deste estudo é o de criar um modelo animal e investigar o efeito da estimulação subliminar do córtex motor (ECM) no limiar nociceptivo e na atividade neuronal subcortical. Método. O limiar nociceptivo foi avaliado por teste plantar e reflexo de retirada da cauda antes e após o implante dos eletródios epidurais sobre o córtex motor da pata posterior orientado por mapa funcional na mesma cepa de ratos. Os mesmos testes foram repetidos antes, durante e após a ECM. Antagonismo sistêmico do por naloxona foi incluído neste protocolo para investigar a relação com mediação opióide. O registro neuronal multiunitário do núcleo centro mediano (CM) e ventral posterolateral (VPL) do tálamo e da substância periaqüeductal (SPM) foi realizado antes, durante e após ECM ipso e contralateral. Resultados. O implante per se não causou alterações no limiar nociceptivo. ECM induziu significativa antinocicepção seletiva na pata contralateral mas não na ipsolateral. Este efeito não mais foi observado 15 minutos após o término da estimulação. Nenhuma alteração motora e comportamental foi observada nos testes de campo aberto. A mesma estimulação no córtex sensitivo e parietal posterior não causou quaisquer alterações de limiar nociceptivo. Administração sistêmica de naloxone reverteu completamente o efeito antes observado com a ECM. O registro neuronal multiunitário evidenciou diminuição na atividade do CM durante e após a ECM contra e ipsolateral. O ritmo de disparos neuronais no VPL também mostrou diminuição apenas com a ECM ipsolateral. No entanto os neurônios da SPM aumentaram significativamente a freqüência de disparos com ECM ipsolateral e não com a contralateral...


Background. The motor function has been associated to sensory and pain attenuation, before during and shortly after the muscle activity. How ever the anatomical and functional basis of this phenomenon is not yet defined. The present study was designed to set an animal model and investigate the effect of subthreshold electrical stimulation of motor cortex (MCS) on pain threshold and neuron activity of thalamus and periaqüedutal gray. Method. Nociceptive thresholds of hind paws and the tail flick reflex were evaluated before and after surgical placement of epidural electrodes; before during and after electrical stimulation of motor cortex. Opioid antagonism was also included in this protocol in order to define neurotransmitter mediation of this process. Multiunit recording of thalamic median center (CM) and ventral posterolateral nuclei (VPL) and lateral periaqüedutal gray (SPM) were performed before and after electrical stimulation of ipso and contralateral motor cortex. Results. The procedure itself did not induce any threshold changes. MCS induced selective antinociception of contralateral paw, but no changes were detected in the nociceptive threshold of the ipsolateral side. This effect disappeared completely 15 minutes after the stimulation was ceased. No behavioral or motor impairment were observed during and after the stimulation session in the open field test. The same stimulation on sensory and posterior parietal cortex did not elicit any changes in behavioral and nociceptive tests. Systemic administration of naloxone completely reversed the previous observed antinociceptive effect. Multiunit recording evidenced decrease in spontaneous neuron firing in CM with short recovery time during ipso and contralateral MCS. Neuron activity in VPL was also significantly decreased during ipsolateral MCS but not with contralateral stimulation. How ever, neuron firing in SPM was significantly...


Asunto(s)
Animales , Ratas , Corteza Motora/fisiología , Estimulación Eléctrica , Dolor , Potenciales de Acción , Conducta , Modelos Animales , Neuronas , Tálamo
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