ABSTRACT
Background: Parkinson's disease is poorly studied in Colombia. It is pharmacologically managed, but for refractory cases, surgery is a therapeutic option, positively impacting on quality of life. Objective: To determine the impact of deep brain stimulation as management in the control of progression in patients with Parkinson's disease attended our institution between the years 2014 to 2020. Method: Descriptive retrospective study, with patients collected between 2014 and 2020 undergoing deep brain stimulation surgery. The MDS-UPDRS (Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale) was applied in the pre- and postoperative period, and the results were compared. Results: 21 patients were included and the UPDRS was applied, finding a decrease in scores in the postoperative period. One patient had an operative site infection. Conclusions: There was an improvement in the MDS-UPDRS score, with a low rate of complications. The procedure time was prolonged from the preoperative evaluation. Deep brain stimulation is the management of choice for refractory Parkinson's disease. The patients in this series showed improvement in their symptoms. Unfortunately, there are limitations to perform this procedure in Colombia, such as the delay in the authorization of the procedure.
Antecedentes: La enfermedad de Parkinson está poco estudiada en Colombia. Es de manejo farmacológico, pero para casos refractarios la cirugía es una opción terapéutica que impacta positivamente en la calidad de vida. Objetivo: Determinar el impacto de la estimulación cerebral profunda como manejo en el control de la progresión en pacientes con enfermedad de Parkinson atendidos nuestra institución entre los años 2014 a 2020. Método: Estudio descriptivo de corte retrospectivo con pacientes recolectados entre los años 2014 y 2020 sometidos a cirugía de estimulación cerebral profunda. Se aplicó la MDS-UPDRS (Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale) en el pre- y el posoperatorio, y se compararon los resultados. Resultados: Se incluyeron 21 pacientes y se les aplicó la MDS-UPDRS, encontrando una disminución en las puntuaciones en el posoperatorio. Un paciente presentó infección del sitio operatorio. Conclusiones: Hubo mejoría en la puntuación de la MDS-UPDRS, con baja tasa de complicaciones. El tiempo de realización del procedimiento fue prolongado desde la valoración preoperatoria. La estimulación cerebral profunda es el manejo de elección para la enfermedad de Parkinson refractaria. Los pacientes de esta serie mostraron mejoría en sus síntomas. Desafortunadamente, existen limitaciones para la realización de este procedimiento en Colombia, como el retraso en la autorización del procedimiento.
ABSTRACT
Objectives To evaluate the surgical management outcomes in pediatric patients with diffuse intrinsic pontine gliomas (DIPGs) who underwent intended biopsies and partial resections in a middle-income country, highlighting the barriers and challenges of these procedures for further investigation. Methods A retrospective review of a prospective acquired series of patients who underwent biopsy or resection for DIPG between January 2012 and June 2018 at our institution was performed. Results A total of 43 patients with posterior fossa tumors were identified. From these, seven pediatric DIPG cases were enrolled. Five were males. The median age was 5 years (range: 1-12 years). Only one patient (14.3%) had a ganglioglioma, while the others presented pilocytic and diffuse astrocytomas. Two (28.6%) patients had an intentional biopsy, and the other five (71.4%) had a partial resection. In the three (28.6%) patients who presented with associated hydrocephalus, the endoscopic third ventriculostomy was performed in the same surgical time. The median preoperative Lansky play-performance scale (LPPS) was 80 (range: 60-100), while the median postoperative LPPS was 23 (range: 7-52). Conclusion A decrease in overall survival was noted compared with data reported in other series. Multifactorial barriers were discussed including the social, geographic, and economic features that may influence on final outcomes.