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Vol. 17. Issue 5.
Pages 420-431 (January 2006)
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Vol. 17. Issue 5.
Pages 420-431 (January 2006)
Tratamiento de la enfermedad de Parkinson con palidotomía y palido-talamotomía estereotáctica guiada por microelectrodos
Microeletrode guided stereotactic pallidotomy and pallido-thalamotomy for treatment of Parkinson's disease
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C. Llumiguano
, T. Dóczi, I. Baths
Department of Neurosurgery. University of Pécs. Hungary
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Resumen
Objetivo

Los autores valoraron el efecto terapéutico de palidotomía y palido-talamotomía combinada guiada por MR y microelectrodos en 33 pacientes con enfermedad de Parkinson, cuyos síntomas fueron resistentes al tratamiento farmacológico.

Material y métodos

Los pacientes fueron evaluados en base a los test estandarizados a nivel internacional que se efectuaron antes y después de la operación: al 2° día, así como a lo largo de 12 meses, con un intervalo de 3 meses entre ellos. Los pacientes fueron divididos en dos grupos; en los del grupo “A”, los síntomas parkinsonianos, incluso el temblor, disminuyeron después de una palidotomía. En los pacientes del grupo “B”, el temblor no disminuyó tras la palidotomía, razón por la cual ésta se complementó con una talamotomía.

Resultados

Con la ayuda de la escala UPDRS III se obtuvieron los siguientes resultados: después de la palidotomía en “fase on” el promedio preoperatorio de 51,2 disminuyó a 29,5 al 2° día, a 26 a los 3, 6 y 9 meses, y a 28,7 a los 12 meses después de la operación; en “fase off” el promedio preoperatorio de 64,3 declinó a 31,6 al 2° día, a 26 a los 3, 6 y 9 meses, y a 30,5 a los 12 meses después de la operación. Después de la palidotalamotomía en “fase on” el promedio preoperatorio de 43,5 disminuyó a 27,9 al 2° día, a 22,9 a los 3 meses, a 22,8 a los 6 meses, y a 24,5 a los 9 y 12 meses después de la operación. De igual manera, en “fase off” el promedio preoperatorio de 62,6 declinó a 38 al 2° día, a 30 a los 3 meses, a 31,8 a los 6 meses, y a 33,8 a los 9 y 12 meses después de la operación.

Conclusión

Para aquellos pacientes, en quienes la palidotomía no fue suficiente en el control del temblor, la palido-talamotomía fue efectiva. Los síntomas clínicos, de acuerdo con las escalas utilizadas, mejoraron significativamente en los dos grupos (student t: P<0,0001); sin embargo, las lesiones bilaterales conllevan un alto riesgo de morbilidad.

Palabras clave:
Enfermedad de Parkinson
Palidotomía
Talamotomía
Abreviaturas:
CRW
GABA
Gpi
Gpii
Gpie
Gpe
MPTP
PPV
UPDRS
Vim
Vop
Abstract
Objective

Authors evaluated the therapeutic effect of the MRI and microelectrodeguided stereotactic pallido- and pallido-thalamotomy in 33 patients with Parkinson's disease (PD), whose symptoms were refractory to pharmacological therapy.

Matherial and methods

The patients were evaluated according to the internationally standardized rating scales (UPDRS part II, III, Schawb & England, Hoehn & Yahr, and Fahn) at six timepoints: before the operation, and 2 days, 3, 6, 9 and 12 months postoperatively. The patients were divided into 2 groups. Those in group A had relief of all main parkinsonian symptoms after pallidotomy including tremor. The patients in group B had no relief of tremor after pallidotomy. For them the pallidotomy was completed by thalamotomy in the same sitting, which had resulted in cessation of tremor.

Results

The following results were obtained by using the UPDRS part III: after pallidotomy “On state” mean: preoperative 51,2, postoperative at 2nd day 29,5 at 3, 6 and 9th month 26, and at 12th month 28,7. “Off state” mean: preoperative 64,3, postoperative at 2nd day 31,6, at 3, 6 and 9th month 26, and at 12th months 30,5. After pallidothalamotomy “On state” mean: preoperative 43,5, postoperative at 2nd day 27,9, at 3rd month 22,9, at 6th month 22,8, and at 9 and 12th month 24,5. “Off state” mean: preoperative 62,6, postoperative at 2nd day 38, at 3rd month 30, at 6th month 31,8 and at 9 and 12th month 33,8.

Conclusions

For those patients, whose tremor was not successfully controlled by pallidotomy, the combined pallido-thalamotomy was effective. The clinical symptomps, according to the rating scales, improved significantly in both groups (student t: P<0,0001), but bilateral lesioning carried higher surgical morbidity.

Key words:
Pallidotomy
Parkinson's disease
Thalamotomy

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