RESUMO
In order to assess the impact of bilateral subthalamic nucleus (STN) stimulation in PD on quality of life, the PD Quality of Life questionnaire was assessed in 60 consecutive patients with PD before surgery and 12 months after surgery. All aspects of quality of life, including motor (+48%), systemic (+34%), emotional (+29%), and social (+63%) dimensions, significantly improved with long-term STN stimulation.
Assuntos
Terapia por Estimulação Elétrica , Procedimentos Neurocirúrgicos , Doença de Parkinson/psicologia , Doença de Parkinson/cirurgia , Qualidade de Vida/psicologia , Núcleo Subtalâmico/fisiologia , Antiparkinsonianos/efeitos adversos , Emoções , Feminino , Seguimentos , Humanos , Levodopa/efeitos adversos , Masculino , Pessoa de Meia-Idade , Comportamento SocialRESUMO
To identify factors predictive of effective bilateral subthalamic nucleus (STN) stimulation for PD with severe motor complications, pre- and postoperative Unified PD Rating Scale (UPDRS) scores were analyzed in a series of 54 patients who received bilateral STN stimulation. Younger age and levodopa responsiveness predict a favorable response to bilateral STN stimulation. For individual PD symptoms, those that improve with a suprathreshold dose levodopa challenge are likely to improve with stimulation.
Assuntos
Terapia por Estimulação Elétrica/estatística & dados numéricos , Doença de Parkinson/cirurgia , Núcleo Subtalâmico/cirurgia , Adulto , Fatores Etários , Idoso , Terapia por Estimulação Elétrica/métodos , Feminino , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Cuidados Pré-Operatórios/estatística & dados numéricos , Análise de Regressão , Estatísticas não ParamétricasAssuntos
Antiparkinsonianos/história , Discinesia Induzida por Medicamentos/história , Terapia por Estimulação Elétrica/história , Levodopa/história , Doença de Parkinson/história , Núcleo Subtalâmico/fisiopatologia , Discinesia Induzida por Medicamentos/terapia , História do Século XX , Humanos , Doença de Parkinson/terapiaAssuntos
Dominância Cerebral/fisiologia , Terapia por Estimulação Elétrica , Globo Pálido/cirurgia , Doença de Parkinson/terapia , Núcleo Subtalâmico/fisiopatologia , Tálamo/cirurgia , Globo Pálido/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Retratamento , Tálamo/fisiopatologiaRESUMO
The limits of drug therapy in severe forms of Parkinson's disease have lead to a renewal of functional neurosurgery of the basal ganglia and the thalamus. Deep brain stimulation (DBS) of these structures was developed with the aims of reducing the morbidity of surgery and of offering an adaptative treatment. DBS was first applied to the thalamus in patients with severe tremor. Tremor of the hemibody is greatly reduced by stimulation of the contralateral electrode in 85% of the cases. There is little change in other symptoms. However, motor fluctuations and dyskinesias are a more frequent problem than severe tremor; in attempt to treat these symptoms, DBS has recently been applied to the subthalamic nucleus (STN) and the internal pallidum (GPi). STN stimulation greatly decreases off motor symptoms and motor fluctuations, which allows a reduction of drug dosage and consequently of dyskinesias. GPi stimulation decreases dyskinesias in most patients, but the effect on off motor symptoms is more variable from one series to another, from very good to nil. The severe morbidity of DBS applied to these 3 targets is low. Comparative studies of the cost and the efficacy of DBS and lesions applied to these different targets are now required.