Neurosurgical Treatment of Movement Disorders: History and Update

Abstract

There has been a quest for surgical treatments for movement disorders for over a century. At first the pyramidal system was interrupted to quiet involuntary motor behavior, but at the cost of paralysis. As knowledge of control of movement advanced during the first part of the last century, the extrapyramidal system became the target, with the goal of alleviating symptoms without weakness. When improved medical management for Parkinson's disease was introduced in the late 1960s, surgery for movement disorders became uncommon, but within the last decade it has rebounded significantly. It now appears that surgery will play an increas-ing role for treatment of motor disorders for the foreseeable future.

Subthalamic deep brain stimulation for the treatment of Parkinson disease

“…Another breakthrough in PD treatment was the introduction of an animal model of PD that helped to identify the neuronal loops. Alternation of those loops resulted in certain symptoms and enabled the identification of anatomical targets for neurosurgical treatment [3,4,8,[21][22][23][24]. The idea of neuromodulation is to suppress the hyperactive elements or interrupt pathways between hyperac-tive and other elements of the loops.…”

“…The mechanism of action of DBS is not fully understood. Currently, the following main mechanisms of action of STN DBS are recognized: depolarization blockage (blockage of sodium channels), synaptic depolarization blockage, antidromic stimulation of the target nucleus with the topical release of GABA, masking of inhibitory coded information and activation of local inhibitory mecha nisms in the target structure [3,[8][9][10]27].…”

“…Deep brain stimulation (DBS), introduced in the 1990s, has become the method of choice for the neurosurgical treatment of PD. The subthalamic nucleus (STN) with its key role in the cortico-basal-thalamo-cortical loop is considered as an optimal target for surgical treatment of the cardinal symptoms of PD [1][2][3][4][5][6][7][8][9][10]. The authors present their experience in the STN DBS treatment of PD.…”

Tratamento cirúrgico funcional da dor

“…Segundo Meyerson 133 , Egas Moniz, em 1936, descreveu a lobotomia pré-frontal para o tratamento das psicoses. Segundo Davis e Stokes 47 , somente muitos anos mais tarde, Freeman e Watts empregaram este método para tratar a dor.…”

“…A hipotalamotomia póstero-medial 196 , a cingulotomia 11 e a capsulotomia anterior 133 são indicados em doentes que apresentam componentes ansiosos, depressivos e obsessivos incapacitantes não controlados com medicação psicotrópica e psicoterapia 71 . Os procedimentos obedecem aos princípios da cirurgia estereotáxica.…”