RESUMO
Continuous jejunal levodopa infusion is an increasingly used therapy option in patients with Parkinson's disease who experience severe fluctuations from oral levodopa. In a number of recent reports polyneuropathy in patients receiving jejunal levodopa infusion was referenced to cobalamin (vitamin B12) deficiency. We describe one of three cases from our hospital with severe subacute polyneuropathy that developed during jejunal levodopa infusion, and occurred despite vitamin substitution therapy and normal vitamin B12 and holotranscobalamin serum levels.
Assuntos
Antiparkinsonianos/administração & dosagem , Antiparkinsonianos/efeitos adversos , Carbidopa/administração & dosagem , Carbidopa/efeitos adversos , Levodopa/administração & dosagem , Levodopa/efeitos adversos , Doença de Parkinson/tratamento farmacológico , Polineuropatias/induzido quimicamente , Idoso , Combinação de Medicamentos , Humanos , Infusões Parenterais , Jejuno , Masculino , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Polineuropatias/tratamento farmacológico , Polineuropatias/fisiopatologia , Vitamina B 12/administração & dosagem , Vitamina B 12/sangueRESUMO
The optimal stimulation site in subthalamic deep brain stimulation (STN-DBS) was evaluated by correlation of the stereotactic position of the stimulation electrode with the electrophysiologically specified dorsal STN border. In a series of 25 electrodes, best clinical results with least energy consumption were found in contacts located in the dorsolateral border zone, whereas contacts within the subthalamic white matter, e.g., zona incerta, were significantly less effective. We suggest that the dorsolateral STN border should be covered by STN-DBS.
Assuntos
Terapia por Estimulação Elétrica/instrumentação , Doença de Parkinson/terapia , Núcleo Subtalâmico/fisiologia , Eletrodos Implantados , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Doença de Parkinson/patologia , Estudos Retrospectivos , Substância Negra/patologia , Núcleo Subtalâmico/patologiaRESUMO
Deep-brain stimulation of the subthalamic nucleus appears to reduce levodopa-induced dyskinesias, but whether this effect is caused by the reduction of the total levodopa ingestion or represents a direct effect on the motor system is unknown. Precision grip force of grasping movements and levodopa-induced dyskinesias was analyzed in 10 parkinsonian patients before and after 3 months of deep-brain stimulation of the subthalamic nucleus. Peak grip force was abnormally increased before surgery in the off-drug state and, particularly, in the on-drug state (sensitization). This grip force upregulation normalized with chronic deep-brain stimulation in both conditions (desensitization). Peak-dose dyskinesias also improved, and off-dystonia was completely abolished. Mean dosage of dopaminergic drugs was reduced, but force overflow and dyskinesias were equally improved in 2 patients without a reduction. Despite the same single levodopa test dose, force excess and levodopa-induced dyskinesias were drastically reduced after 3 months of deep-brain stimulation of the subthalamic nucleus. This indicates that direct effects of deep-brain stimulation of the subthalamic nucleus on levodopa-induced dyskinesias are likely to occur. Grip force overflow is a promising parameter to study the desensitizing effect of chronic deep-brain stimulation on levodopa-induced dyskinesias.