No abstract
Deep brain stimulation (DBS) has been widely used to control motor symptoms and improve quality of life in patients with Parkinsons disease (PD). Recently, DBS in the subthalamic nucleus (STN) has become the preferred target for patients with mixed motor symptoms. Despite resultant motor and quality of life improvements, the procedure has been associated with cognitive decline, mainly in language skills, and also with psychiatric symptoms.ObjectiveTo evaluate the influence of DBS in the STN on cognition, mood and quality of life.MethodsWe studied 20 patients with PD submitted to DBS in the STN from May 2008 to June 2012 with an extensive battery of cognitive tests including memory, language, praxis, executive functions and attention assessments; the Parkinson's Disease Quality of Life Questionnaire (PDQ-39); and the Hospital Anxiety and Depression Scale (HAD), were applied both before and after the surgery. Data was analyzed using SPSS version 17.0 and results compared using the paired Student's t test.ResultsA total of 20 patients with pre and post-operative assessments were included. A statistically significant improvement was found in total score and on subscales of mobility, activities of daily living and emotional well-being from the PDQ-39 (P=0.009, 0.025, 0.001 and 0.034, respectively). No significant difference was found on the cognitive battery or mood scale.ConclusionDBS in the SNT improved quality of life in PD with no negative impact on cognitive skills and mood.
RESUMOFerimentos provocados por projétil de arma de fogo na região cervical alta (C1-C2) são raros. Apresentamos experiência recente com cinco vítimas desses ferimentos, localizados nessa região e que não apresentavam déficit neurológico. Em todos os casos foi adotada conduta conservadora que consistiu na imobilização cervical externa, com colar tipo Filadélfia, por um período de três meses. Todos os pacientes permaneceram sem alteração no exame neurológico no seguimento de um ano. Concluímos que nessas situações o tratamento conservador é alternativa adequada. PALAVRAS-CHAVETraumatismo raquimedular. Ferimento por arma de fogo. ABSTRACT Gunshot wounds to the upper cervical spine. Conservative treatmentGunshot wounds to the upper cervical spine, i.e., at the atlanto-axial complex, are unusual events. We present a series of five patients with gunshot wounds to the upper cervical spine without neurologic impairment. Conservative management which consisted in Philadelphia orthesis for cervical immobilization, during three months was adopted in all cases Neurological status remained unchanged in all patients over one year follow up. We conclude that conservative management is an adequate option for such cases.
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