Preliminary results in surgery of Parkinson's disease

Abstract

The authors present the preliminary results of 20 patients selected to be operated on between January 1996 and April 1997. These patients presented one of the present indications for stereotactic posteroventral pallidotomy (PVP), such as: rigidity, akinesia/bradykinesia, gait dysfunction, drug induced dyskinesias and tremor. Every patient of this protocol was evaluated by: UPDRS score, Schwab and England scale, Hoehn and Yahr Staging Scale before and after surgery. The results in 3 months showed a remarkable improvement after PVP (P < 0.01) in all functional assessments, except for facial expression, speech and posture. The morbidity was 5%. 5 patients (25%) who were in Hoehn and Yahr 5 underwent a bilateral simultaneous PVP. In 5 patients (25%), who had tremor, during the PVP, VIM thalamotomy was added. These preliminary results, suggest that PVP is highly effective for PD symptoms.

Pallidotomy for Parkinson disease: a review of contemporary literature

“…7,12,42,43,52,56,61,62,65,66,72,77 This improvement was also documented at 6 months (73.5% of 94 assessable patients) and 12 months (86.4% of 71 assessable patients) postoperatively (Table 1). 12,24,42,56,77 The number of studies in which 6-and 12-month outcomes were documented by using UPDRS tremor and rigidity scores for the contralateral side during the off period was very limited, and each study contained data based on different parts of the scale.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][22][23][24][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85]…”

“…2,4,6,9,10,12,15,18,20,22,23,26,27,30,36,39,[42][43][44][45]48,52,54,56,[60][61][62][63][64]66,68,72,73,75,77,78,[81][82][83]86,88,89 The deaths were usually related to the occurrence of large intracerebral hemorrhages. Cerebral hemorrhages were the most significant complications, occurring in 26 cases (1.7%).…”

Estimulação cerebral contínua (DBS) talâmica para controle do tremor

“…Atualmente é bem aceito que a estimulação do VIM promova efeitos similares aos da talamotomia, sem seus efeitos adversos e seus riscos de lesão permanente [20][21][22][23] . Mas o mecanismo de ação da ECP ainda é objeto de pesquisa [24][25][26] .…”

Estimulação cerebral profunda no núcleo subtalâmico para doença de Parkinson

“…Baseados neste modelo fisiopatológico recente, muitos estudos têm demonstrado que lesão ou bloqueio da atividade do GPI ou do NST podem reverter estas anormalidades funcionais [1][2][3][4] . A estimulação cerebral profunda crônica (ECPC) se vale da possibilidade de obter os mesmos efeitos funcionais das ablações reduzindo as complicações permanentes, principalmente quando forem bilaterais [5][6][7][8][9][10][11] . A história da neurocirurgia funcional para os sintomas motores da DP se confunde com a própria história de neurocirurgia.…”