RESUMEN
BACKGROUND: Deep brain stimulation (DBS) at the subthalamic nucleus (STN) or globus pallidus internus (GPi) can effectively treat the motor symptoms of Parkinson's disease, but dual implantation is rare. We report the first cases of additional GPi stimulation as rescue therapy for disabling dyskinesias following successful STN stimulation. METHODS: Two patients, initially treated with bilateral STN DBS, underwent subsequent bilateral GPi DBS after the development of refractory dyskinesias within 1 and 6 years of STN surgery. Patients were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS) before and after surgeries for STN and GPi DBS. RESULTS: GPi DBS effectively suppressed dyskinesias in these patients and improved their quality of life, as demonstrated by their videos and UPDRS scores. CONCLUSIONS: Additional bilateral GPi DBS may be considered in the rare instance of patients who develop refractory dyskinesias early or late after bilateral STN DBS.
Asunto(s)
Estimulación Encefálica Profunda/métodos , Globo Pálido/fisiopatología , Trastornos Parkinsonianos/terapia , Terapia Recuperativa/métodos , Núcleo Subtalámico/fisiopatología , Adulto , Anciano , Antiparkinsonianos/uso terapéutico , Terapia Combinada , Estimulación Encefálica Profunda/instrumentación , Resistencia a Medicamentos , Electrodos Implantados , Femenino , Humanos , Imagenología Tridimensional , Masculino , Trastornos Parkinsonianos/diagnóstico por imagen , Trastornos Parkinsonianos/tratamiento farmacológico , Trastornos Parkinsonianos/fisiopatología , Calidad de Vida , Recurrencia , Tomografía Computarizada por Rayos XAsunto(s)
Dopaminérgicos/efectos adversos , Trastornos Mentales/inducido químicamente , Trastornos Parafílicos/inducido químicamente , Adulto , Dopaminérgicos/uso terapéutico , Humanos , Masculino , Trastornos Mentales/tratamiento farmacológico , Trastornos Parafílicos/tratamiento farmacológico , Trastornos Parkinsonianos/tratamiento farmacológicoRESUMEN
This paper reviews the theories of the pathogenesis of atopic dermatitis (AD), with a particular emphasis on its immunopathogenesis. The contribution of predisposing factors, immunopathogenic factors and provoking factors in the pathogenesis of AD are considered. Predisposing factors explored in this article include genetics and the disturbance of skin function. Immunopathogenic factors reviewed include T cell dysfunction, biphasic cytokine expression and the role of immunoglobulin E. Provoking factors considered include microbial factors, psychosomatic interactions, contact allergens and irritants, inhalant allergens, food and climate. Immunosuppressive treatments reviewed include cyclosporin, azathioprine, methotrexate, tacrolimus, interferon-gamma, phosphodiesterase inhibitors and pimecrolimus (SDZ ASM 981).