ORIGINAL
Introdução: A doença de Parkinson é uma doença neurodegenerativa caracterizada principalmente por sintomas motores,`com sintomas sensoriais, cognitivo-comportamentais, autonômicos e do sono. Medicamentos dopaminérgicos podem aliviar um subconjunto destes sintomas. Estimulação cerebral profunda (DBS) melhora os sintomas motores e qualidade de vida, sendo sua vantagem mais importante a da manutenção de um nível constante de estimulação durante todo o dia. Objetivo: Determinar o perfil e a percepção dos resultados de pacientes submetidos a implante de DBS para a doença de Parkinson em um hospital neurológico terciário. Métodos: Vinte e um pacientes diagnosticados com doença de Parkinson e submetidos a implante de DBS entre maio de 2010 a dezembro de 2013, no Instituto de Neurologia de Curitiba, foram incluídos em uma análise retrospectiva, com revisão de seus registros médicos. Através de contato telefônico responderam a um questionário sobre sua percepção do procedimento e seus resultados. Resultados: Todos os pacientes foram avaliados pelo menos um ano após o procedimento. Idade média na implantação foi 64,42 anos (29% mulheres e 71% homens). Dos 21 pacientes selecionados, somente 17 puderam ser contatados (1 paciente havia falecido e 3 não foram encontrados). Setenta e um por cento se submeteriam ao procedimento novamente e 76% que recomendaria para outra pessoa. Discussão: DBS do núcleo subtalâmico (STN) alivia flutuações motoras e discinesias associadas à doença de Parkinson, com benefício prolongado. Tratamento com DBS tem bom resultado na maioria dos pacientes e é uma boa opção terapêutica a ser considerada em casos selecionados. Novas pesquisas com amostras maiores podem auxiliar no aperfeiçoamento do tratamento oferecido aos pacientes portadores de doença de Parkinson visando uma melhor qualidade de vida.
Introduction: Parkinson’s disease is a neurodegenerative disorder characterized mainly by motor impairment, with sensory, autonomic cognitive-behavioral and sleep-related symptoms. Dopaminergic medications can alleviate a subset of these symptoms. Deep Brain Stimulation (DBS) improves motor symptoms and quality of life in Parkinson’s disease with the most important advantage of maintenance of a constant level of stimulation throughout the day. Objective: To determine the profile and perception of results of patients who underwent implantation of DBS for Parkinson’s disease in a tertiary neurological hospital. Methods: Patients who had a diagnosis of Parkinson’s disease and were submitted to implantation of DBS between May 2010 and December 2013, in our service, were included in a retrospective analysis. Medical records were reviewed and, via telephone contact, they responded to a questionnaire on their perception of the procedure and its results. Results: Twenty-one procedures were performed for implantation of DBS in patients with Parkinson’s disease. All patients were evaluated at least one year after the procedure. Average age at implantation was 64.42 years (29% female, 71% male). Seventeen patients could be contacted of the 21 selected patients (1 patient was deceased and 3 were not possible to reach). Seventy-one percent would agree to be submitted to the procedure again and 76% would recommend it to someone else. Discussion: DBS of the subthalamic nucleus (STN) relieves motor fluctuations and dyskinesias associated with Parkinson’s disease, with sustained benefit. Treatment with DBS has good outcome in most patients and is a good therapeutic option to be considered in selected cases. Further researches with larger samples can aid in the improvement of the treatment offered to patients with Parkinson’s disease for a better quality of life.
1. Altuğ F, Acar F, Acar G, Cavlak U. The effects of brain stimulation of subthalamic nucleus surgery on gait and balance performance in Parkinson disease. A pilot study. Arch Med Sci. 2014;10(4):733-738
2. Ferrara J, Diamond A, Hunter C, Davidson A, Almaguer M, Jankovic J. Impact of STN-DBS on life and health satisfaction in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2010;81(3):315-319
3. Iachinski RE, de Meneses MS, Simão CA, da Rocha SF, de Oliveira Braga F, Kowacs PA. Patient satisfaction with temporal lobectomy/selective amygdalohippocampectomy for temporal lobe epilepsy and its relationship with Engel classification and the side of lobectomy. Epilepsy Behav. 2014;31:377-380
4. Maier F, Lewis CJ, Horstkoetter N, et al. Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson’s disease: a mixed-method approach. J Neurol Neurosurg Psychiatry. 2013;84(11):1273-1281
5. Odekerken VJ, van Laar T, Staal MJ, et al. Subthalamic nucleus versus globus pallidum bilateral deep brain stimulation for advanced Parkinson’s disease (NSTAPS study): a randomized controlled trial. Lancet Neurol. 2013;12(1):37-44
6. Rothlind JC, York MK, Carlson K, et al. Neuropsychological changes following deep brain stimulation surgery for Parkinson’s disease: comparisons of treatment at pallidal and subthalamic targets versus best medical therapy. J Neurol Neurosurg Psychiatry. 2014. pii: jnnp-2014-308119.
7. Stroupe KT, Weaver FM, Cao L, et al. Cost of Deep Brain Stimulation for the Treatment of Parkinson’s disease by Surgical Stimulation Sites. Mov Disord. 2014;29(13):1666-7.
1MD, Neurology Department, Instituto de Neurologia de Curitiba
2MD, MSc, Neurosurgery Department, Instituto de Neurologia de Curitiba
3MD, PhD, Chief of Neurosurgery Department, Instituto de Neurologia de Curitiba
Received Apr 13, 2015. Accepted May 13, 2015
