Influencia de la estimulación cerebral profunda en la carga de cuidadores de pacientes con enfermedad de Parkinson / Deep brain stimulation for patients with Parkinson's disease: Effect on caregiver burden

INTRODUCCIÓN: Nuestro objetivo es determinar el grado de carga de cuidadores de pacientes con enfermedad de Parkinson en tratamiento con estimulación cerebral profunda (ECP) con respecto a aquellos en estadios avanzados con otros tratamientos y las variables asociadas a la presencia de sobrecarga. MATERIAL Y MÉTODOS: Se incluyeron de forma consecutiva pacientes con enfermedad de Parkinson en tratamiento con ECP, utilizando como grupo control a otros con enfermedad de Parkinson en estadio avanzado sin ECP. Los pacientes fueron sometidos a una valoración mediante las escalas UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn y Yahr, Schawb & England, Barthel, PDQ-39, MoCA, Apathy Scale, HADS y la QUIP abreviada. A los cuidadores se les estudió mediante el inventario de sobrecarga de Zarit y de valoración afectiva HADS. RESULTADOS: Se incluyeron 11 pacientes en tratamiento con ECP y 11 con otros tratamientos. En aquellos con ECP se observó una mejor calidad de vida según la escala PDQ-39 (p = 0,028), y una menor puntuación en la subescala HADS para la ansiedad (p = 0,010). Se observó sobrecarga en un 54,5% de los cuidadores de pacientes de ambos grupos (p = 1,000), con una puntuación similar en la escala Zarit (p = 0,835). La presencia de sobrecarga se asoció a una mayor puntuación en la escala de apatía (p = 0,048) y en la subescala HADS de ansiedad en el cuidador (p = 0,006). CONCLUSIÓN: Según los resultados de nuestro estudio el tratamiento con ECP no se relaciona con una menor carga del cuidador, siendo la apatía del paciente y la ansiedad del cuidador factores asociados a su desarrollo

INTRODUCTION: Our aim is to assess the burden on caregivers of patients with Parkinson's disease treated with deep brain stimulation (DBS) compared to those caring for patients at advanced stages and undergoing other treatments. We have also assessed the variables associated with presence of caregiver overload. MATERIAL AND METHODS: We included consecutive patients with Parkinson's disease treated with DBS. Our control group included patients in advanced stages of Parkinson's disease undergoing other treatments. Patients were assessed with the following scales: UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn and Yahr, Schwab & England, Barthel, PDQ-39, MoCA, Apathy Evaluation Scale, HADS, and the abbreviated QUIP. Caregiver burden was evaluated with the Zarit caregiver burden interview and their moods were assessed with the HADS scale. RESULTS: We included 11 patients treated with DBS and 11 with other treatments. For patients treated with DBS, we observed a better quality of life according to the PDQ-39 questionnaire (P = .028), and a lower score on the HADS anxiety subscale (P = .010). Caregiver overload was observed in 54.5% of the caregivers of patients in both groups (P = 1.000); Zarit scores were similar (P = .835). Caregiver overload was associated with higher scores on the caregiver's Apathy Evaluation Scale (P = .048) and on the HADS anxiety subscale (P = .006). CONCLUSION: According to our results, treatment with DBS is not associated with lower caregiver burden. Apathy in patients and anxiety in caregivers are factors associated with the appearance of overload

Deep brain stimulation for patients with Parkinson's disease: Effect on caregiver burden. / Influencia de la estimulación cerebral profunda en la carga de cuidadores de pacientes con enfermedad de Parkinson.

INTRODUCTION: Our aim is to assess the burden on caregivers of patients with Parkinson's disease treated with deep brain stimulation (DBS) compared to those caring for patients at advanced stages and undergoing other treatments. We have also assessed the variables associated with presence of caregiver overload. MATERIAL AND METHODS: We included consecutive patients with Parkinson's disease treated with DBS. Our control group included patients in advanced stages of Parkinson's disease undergoing other treatments. Patients were assessed with the following scales: UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn and Yahr, Schwab & England, Barthel, PDQ-39, MoCA, Apathy Evaluation Scale, HADS, and the abbreviated QUIP. Caregiver burden was evaluated with the Zarit caregiver burden interview and their moods were assessed with the HADS scale. RESULTS: We included 11 patients treated with DBS and 11 with other treatments. For patients treated with DBS, we observed a better quality of life according to the PDQ-39 questionnaire (P=.028), and a lower score on the HADS anxiety subscale (P=.010). Caregiver overload was observed in 54.5% of the caregivers of patients in both groups (P=1.000); Zarit scores were similar (P=.835). Caregiver overload was associated with higher scores on the caregiver's Apathy Evaluation Scale (P=.048) and on the HADS anxiety subscale (P=.006). CONCLUSION: According to our results, treatment with DBS is not associated with lower caregiver burden. Apathy in patients and anxiety in caregivers are factors associated with the appearance of overload.

[T-type primary lymphoma of the central nervous system in immunocompetent patients]. / Linfoma primario tipo T del sistema nervioso central en pacientes inmunocompetentes.

INTRODUCTION: The primary lymphoma of the central nervous system is an infrequent neoplasia, which represents 1,5% of all primary neoplasias in adult patients. In the last decade its frequency has increased threefold, both in immunodepressed as well as in immunocompetent patients. The non Hodgkin lymphoma of B cells being the most frequent histological type, the primary T cell lymphoma of the CNS is a rare clinical entity. CASE REPORTS: In this study we present three cases of immunocompetent patients with primary lymphoma of the central nervous system of T cells seen during the 6 last years in our hospital, the diagnostic imaging by computerized tomography and magnetic resonance showed the tumorations, but the definitive diagnosis was by stereotaxic cerebral biopsy. CONCLUSIONS: The lymphomas are radiosensitive to radiotherapy with survivals of approximately 26 months, the combined treatment of surgery and chemotherapy, prior to radiotherapy, may increases survival up to 48 months. Certain aspects of the patient or of the tumor itself are determining factors with respect to the prognosis of survival. We review the relevant literature and study the clinical manifestation, their value of imaging techniques and differential diagnostic and prognosis of survival

Linfoma primario tipo T del sistema nervioso central en pacientes inmunocompetentes / T-type primary lymphoma of the central nervous system in immunocompetent patients

Introducción. El linfoma primario del sistema nervioso central (LPSNC) es una neoplasia poco frecuente, que representa el 1,5 per cent de todas las neoplasias primarias cerebrales en pacientes adultos. En esta última década se ha triplicado su frecuencia, tanto en pacientes inmunodeprimidos como en inmunocompetentes. El linfoma no Hodgkin de células B es el tipo histológico más frecuente, mientras que el linfoma primario de célula tipo T del SNC es una entidad clínica infrecuente. Casos clínicos. En este estudio presentamos tres casos de pacientes inmunocompetentes con LPSNC de celularidad T estudiados en nuestro hospital, en los seis últimos años; el diagnóstico por imagen se realizó mediante tomografía axial computarizada y resonancia magnética, y se llegó al diagnóstico definitivo mediante biopsia cerebral estereotáxica. Conclusiones. Los linfomas son tumores radiosensibles, con supervivencias aproximadas de 26 meses; la combinación de cirugía y quimioterapia, previa a la radioterapia, puede aumentar la supervivencia por encima de los 48 meses; aspectos propios del paciente y del tumor son determinantes con respecto al pronóstico de supervivencia. Se realiza una amplia revisión de la bibliografía respecto a este tipo específico de linfoma primario cerebral, sus manifestaciones clínicas, sus hallazgos radiológicos, diagnósticos diferenciales y pronóstico de supervivencia (AU)

Introduction. The primary lymphoma of the central nervous system is an infrequent neoplasia, which represents 1,5% of all primary neoplasias in adult patients. In the last decade its frequency has increased threefold, both in immunodepressed as well as in immunocompetent patients. The non-Hodgkin lymphoma of B cells being the most frequent histological type, the primary T-cell lymphoma of the CNS is a rare clinical entity. Case reports.In this study we present three cases of immunocompetent patients with primary lymphoma of the central nervous system of T cells seen during the 6 last years in our hospital, the diagnostic imaging by computerized tomography and magnetic resonance showed the tumorations, but the definitive diagnosis was by stereotaxic cerebral biopsy. Conclusions. The lymphomas are radiosensitive to radiotherapy with survivals of approximately 26 months, the combined treatment of surgery and chemotherapy, prior to radiotherapy, may increases survival up to 48 months. Certain aspects of the patient or of the tumor itself are determining factors with respect to the prognosis of survival. We review the relevant literature and study the clinical manifestation, their value of imaging techniques and differential diagnostic and prognosis of survival (AU)

[Endoscopic treatment of intracranial lesions. Apropos of 8 cases]. / Traitement endoscopique des lésions intracrâniennes. A propos de 8 cas.

The authors describe their initial experience involving endoscopic techniques used in the treatment of eight patients with varied brain lesions. Two tumours and a colloid cyst of the third ventricle, two paraventricular symptomatic cysts, one arachnoid cyst, one chronic intracerebral hematoma and one case of free catheter extraction in the lateral ventricle. The common characteristics of all these lesions were their liquid character and/or intraventricular location. Rigid endoscopes were used, with 9 and 6 mm work channels and independent aspiration and irrigation systems. The optic elbow makes direct visualization and adaptation to the TV monitor possible. The endoscope was manually directed at the lesion through a 12 mm burr hole in five cases and by means of a stereotactic frame in three cases. Biopsies were obtained in six cases. In three cases a communication between the cyst and the ventricular system or adjacent cisterns was established and in two cases vaporization of the lesion using a CO2 laser was performed. Tolerance to the endoscopic procedures was good in all cases. In the authors' opinion, endoscopic techniques constitute a low risk method, midway between stereotactic techniques and the microsurgical approach, and are especially indicated in the treatment of cystic brain lesions or those situated in or near the ventricular system. Their most notable advantages are: providing direct visualization of the lesion without interference from the instruments in the operating field; non-repercussion of the spatial changes derived from the liquid outlet and possibility of lesion coagulation and manipulation. Their disadvantages, related to the use of very long instruments and from a reduced work channel, must be overcome by specialized training.