RESUMO
The authors report the case of DYT1-positive primary generalized dystonia refractory to medical management that was successfully treated with continuous deep brain stimulation of the internal segment of the globus pallidus. Prior studies have shown that neuromusculoskeletal deficits can remain permanent if early surgical intervention is not undertaken. The authors report prolonged efficacy and safety over a 10-year period in a 28-year-old man.
Assuntos
Estimulação Encefálica Profunda/métodos , Distonia Muscular Deformante/genética , Distonia Muscular Deformante/terapia , Globo Pálido/fisiologia , Chaperonas Moleculares/genética , Adulto , Distúrbios Distônicos/terapia , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Resultado do TratamentoRESUMO
OBJECTIVE: To propose a new model of integrated, multidisciplinary postoperative care of the patients with deep brain stimulation (DBS). DESIGN: Observational cohort study with follow-up at 3 months and 1 year. SETTING: Academic medical center movement disorder clinic. PARTICIPANTS: Seventy-three consecutive patients with medically refractory Parkinson's disease underwent bilateral DBS. Patients were then transferred directly to an inpatient rehabilitation facility. INTERVENTION: DBS and inpatient programming and rehabilitation. Simultaneous programming and rehabilitation was carried out by a multidisciplinary team. MAIN OUTCOME MEASURES: The FIM instrument, Unified Parkinson Disease Rating Scale (UPDRS), and levodopa dosage. RESULTS: The average rehabilitation stay was 17.3 days, with a mean of 6.2 stimulator adjustments during that time. FIM scores improved from 62.1 (admission) to 98.5 (discharge), an average improvement of 36.4 (58.6%). Average UPDRS scores improved from 52.5 (preoperative off) and 30.1 (preoperative on) to 20.4 (3mo postoperative on-medication, on-stimulation), a 32.2% improvement from the preoperative on score. Levodopa dosages decreased by an average of 48.3% (all P<.001). CONCLUSIONS: We describe our fast-track protocol, which allows for rapid DBS programming and tapering of Parkinson's medications. It also provides for treatment of concomitant medical and psychologic problems and optimized physical performance.
