2016, Number S2
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ABSTRACTBackground: Parkinson’s disease justifies the use of deep brain stimulation (DBS) in certain patients who suffer from this condition. We present mid-term and long-term post-surgical outcomes in a cohort of 60 patients, who underwent DBS in the Hospital de Especialidades at Centro Médico Nacional Siglo XXI, in Mexico City.
Methods: Patients underwent conventional stereotactic surgery with FrameLink software (Medtronics Inc). This technique consisted in the presurgical evaluation, the placement of stereotactic frame, imaging studies, preoperative planning procedure, microrecording, macrostimulation, as well as the placement of electrodes and generators in two phases. The variables were included in a data platform for Excel management. It was also included a variety of measurement instruments for data comparison. As a standard measure, it was used the Unified Parkinson Disease Rating Scale (UPDRS) before the surgery and at 3, 12, and 36 months.
Results: 60 patients underwent surgery: 41 men and 19 women, with an average age of 56.5 years (39-70). There were good results in the majority of patients with preoperative UPDRS and at 3, 12 and 36 months of 79.57, 66.85, 65.29 and 58.75, respectively (p ‹ 0.0001). There were complications in nine patients (15 %) and they were managed in a conservative manner.
Conclusions: Postsurgical outcomes were from good to excellent in the majority of patients. Complications were minimal and conservatively managed. We propose the use of this procedure in a selected group of Parkinson’s patients.
Sprenger F, Poewe W. Management of motor and non-motor symptoms in Parkinson’s disease. CNS Drugs. 2013 Apr;27(4):259-72.
Pringsheim T, Jette N, Frolkis A, Steeves TD. The prevalence of Parkinson’s disease: A systematic review and meta-analysis. Mov Disord. 2014 Nov;29(13):1583-90.
Pigott K, Rick J, Xie SX, Hurtig H, Chen-Plotkin A, Duda JE, et al. Longitudinal study of normal cognition in Parkinson disease. Neurology. 2015 Oct 13;85(15):1276- 82. doi: 10.1212/WNL.0000000000002001.
Pérez de la Torre RA, Dorantes-Argandar A. Surgical management of Parkinson’s disease. Contemporary Neurosurgery. 33(2):1-6, January 30, 2011.
Contarino MF, Bour LJ, Verhagen R, Lourens MA, de Bie RM, van den Munckhof P, et al. Directional steering: A novel approach to deep brain stimulation. Neurology. 2014 Sep 23;83(13):1163-9.
Savas A, Bozkurt M, Akbostancı C. A comparison between stereotactic targeting methods of the subthalamic nucleus in cases with Parkinson’s disease. Acta Neurochir Suppl. 2013;117:35-41.
Hariz MI, Hariz GM. Therapeutic stimulation versus ablation. Handb Clin Neurol. 2013;116:63-71.
DeLong MR, Wichmann T. Basal Circuits as Targets for Neuromodulation in Parkinson Disease . JAMA Neurol. 2015 Sep 26:1-7.
Metman LV Slavin KV. Advances in functional neurosurgery for Parkinson’s disease. Mov Disord. 2015 Sep 15;30(11):1461-70.
Pallavaram S, DʼHaese PF, Lake W, Konrad PE, Dawant BM, Neimat JS. Fully automated targeting using nonrigid image registration matches accuracy and exceeds precision of best manual approaches to subthalamic deep brain stimulation targeting in Parkinson disease. Neurosurgery. 2015 Jun;76(6):756-65.
Anthofer J, Steib K, Fellner C, Lange M, Brawanski A, Schlaier J. The variability of atlas-based targets in relation to surrounding major fibre tracts in thalamic deep brain stimulation. Acta Neurochir (Wien). 2014 Aug;156(8):1497-504; discussion 1504.
Sako W, Miyazaki Y, Izumi Y, Kaji R. Which target is best for patients with Parkinson’s disease? A metaanalysis of pallidal and subthalamic stimulation. J. Neurol Neurosurg Psychiatry. 2014 Sep;85(9):982-6.
He Z, Jiang Y, Xu H, Jiang H, Jia W, Sun P, et al. High frequency stimulation of subthalamic nucleus results in behavioral recovery by increasing striatal dopamine release in 6-hydroxydopamine lesioned rat. Behav Brain Res. 2014 Apr 15;263:108-14.
Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease. A clinico-pathological study of 100 cases. Journal Neurology Neurosurgery Psychiatry. 1992;55:181-4.
Goetz C, Stebbins G. Assuring interrater reliability for the UPDRS motor section: utility of the UPDRS teaching tape. Mov Disord. 2004 Dec;19(12):1453-6.
Pérez de la Torre RA. Manejo quirurgico de la enfermedad de Parkinson mediante métodos ablativos. En León-Flores L. Cuevas-García C, editores. Enfermedad de Parkinson, perspectivas actuales y futuras. Ciudad de México, México: Planeación y desarrollo editorial; 2007. pp. 247-54.
Pérez de la Torre R. Manejo futuro de la enfermedad de Parkinson. En León-Flores L. Cuevas-García C., editores. Enfermedad de Parkinson, perspectivas actuales y futuras. Ciudad de México, México: Planeación y desarrollo editorial; 2007. 256-61.
Merola A, Romagnolo A, Bernardini A, Rizzi L, Artusi CA, Lanotte M, et al. Earlier versus later subthalamic deep brain stimulation in Parkinson’s disease. Parkinsonism Relat Disord. 2015 Aug;21(8):972-5.
De Souza RM, Moro E, Lang AE, Schapira AH. Timing of deep brain stimulation in Parkinson disease: a need for reappraisal? Ann Neurol. 2013 May;73(5):565-75.
Charles PD, Dolhun RM, Gill CE, Davis TL, Bliton MJ, Tramontana MG, et al. Deep brain stimulation in early Parkinson’s disease: enrollment experience from a pilot trial. Parkinsonism Relat Disord. 2012 Mar;18(3):268-73.
Shalash A, Alexoudi A, Knudsen K, Volkmann J, Mehdorn M, Deuschl G.The impact of age and disease duration on the long-term outcome of neurostimulation of the subthalamic nucleus. Parkinsonism Relat Disord. 2014 Jan;20(1):47-52.
Lilleeng B, Gjerstad M, Baardsen R, Dalen I, Larsen JP. Motor symptoms after deep brain stimulation of the subthalamic nucleus. Acta Neurol Scand. 2015 May;131(5):298-304.
Okun M. Deep-brain stimulation--entering the era of human neural-network modulation. N Engl J Med. 371;15:1369-73.
Weaver F. Follett K. Hur K. Ippolito D. Stern M. Deep brain stimulation in Parkinson’s disease: a meta-analysis of patient outcomes. J. Neurosurg. 2005;103:956-67.
Welter ML, Schüpbach M, Czernecki V, Karachi C, Fernandez-Vidal S, Golmard JL, et al. Optimal target localization for subthalamic stimulation in patients with Parkinson disease. Neurology. 2014 Apr 15;82(15):1352-61.
Liu Y, Li W, Tan C, Liu X, Wang X, Gui Y, et al. Meta- analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease. J Neurosurg. 2014 Sep;121(3):709-18.
Tong F, Ramirez-Zamora A, Gee L, Pilitsis J. Unusual complications of deep brain stimulation. Neurosurg Rev. 2015 Apr;38(2):245-52; discussion 252. doi: 10.1007/s10143-014-0588-9.