Protocol of procedure in deep brain stimulation for treatment of Parkinson disease [Protocolo de procedimento na estimulação cerebral profunda para tratamento da doenç de Parkinson]

• Type: Article in International Scientific Journal
• Date: 2007

Authors

Linhares, P (Author) Other; Rosas, MJ (Author) Other; Ayres Basto, M (Author) Other; Fonseca, R (Author) Other; Garrett, C (Author) FMUP; Vaz, R (Author) Other

Journal

Title: Sinapse

Vol. 7

Pages: 23-27

ISSN: 1645-281X

Publisher: Sociedade Portuguesa de Neurologia

Indexing

ISI Web of Knowledge

Scopus - 1 Citation

Other information

Authenticus ID: P-007-HT6

Abstract (EN): Aims: Participation in an international procedure standard definition in deep brain stimulation (DBS) for treatment of Parkinson disease. Material and Methods: In accordance with the protocol previously defined we evaluate retrospectively the effectiveness of the procedure, the determination of the target, the surgical time and the adverse effects in the 37 patients submitted to deep brain stimulation - subtalamic nucleus (DBS-STN) in Hospital S. João. The effectiveness was evaluated by UPDRS III without medication - off, (MedOFF/StimOFF) and on (MedOFF/StimON) stimulation. In the determination of the target the comparison between the initial anatomic target and the definitive rank of the electrode was done. To evaluate security, adverse effects after the implantation, including symptomatic hemorrhages, had been reviewed. For the determination of the surgical time the intraoperative registrations had been reviewed in all patients. The patients were under local anesthesia, without sedation, in a position with the trunk rose between the 45 and 60°, and in all of them 4 or 5 trajectories were done. The results were presented in mean± standard deviation. The mean values for UPDRS 3, (MedOFF/ StimOFF) and for (MedOFF/ StimON), mean values for levodopa doses before and after surgery were compared by paired sample t test. Statistical significance were considered for p<0,05. Results: Motor benefit of the surgical treatment was 69%, with a reduction of 57% in daily medication. In the definition of the final target, only in 25% of the cases the definitive position of the electrode coincided with the anatomic target pre-determined by imagiology. The initial surgical time was reduced in 4 hours (33% of reduction). The post-surgery adverse effects were one symptomatic hemorrhage, one infection in the implanted system, one worsening of depression and a reimplantation of one electrode that was incorrectly implanted. Conclusions: The systematization of the surgical steps, the improvement of the logistic conditions and the experience of team may change the result. The determination of the target by image is unsatisfactory, except for changing small details. So definitive implantation must be done also based on the electrophysiological results and per-operative stimulation. It will be a goal to define international criteria of quality. The DBS has a clearly benefit in treatment of the motor symptoms of Parkinson Disease and is secure, being the majority of the complications transitory.

Language: Portuguese

Type (Professor's evaluation): Scientific

No. of pages: 5