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
C. Llumiguano
, T. Dóczi, I. Baths
Department of Neurosurgery. University of Pécs. Hungary
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Baths" "autores" => array:3 [ 0 => array:3 [ "nombre" => "C." "apellidos" => "Llumiguano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Dóczi" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Baths" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Department of Neurosurgery. University of Pécs. Hungary" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Department of Neurosurgery. University of Pécs. H-7623, Pécs, Rét utca 2 sz. Hungary." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Microeletrode guided stereotactic pallidotomy and pallido-thalamotomy for treatment of Parkinson's disease" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-05-10" "fechaAceptado" => "2005-08-29" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159386" "palabras" => array:3 [ 0 => "Enfermedad de Parkinson" 1 => "Palidotomía" 2 => "Talamotomía" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec159385" "palabras" => array:11 [ 0 => "CRW" 1 => "GABA" 2 => "Gpi" 3 => "Gpii" 4 => "Gpie" 5 => "Gpe" 6 => "MPTP" 7 => "PPV" 8 => "UPDRS" 9 => "Vim" 10 => "Vop" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159387" "palabras" => array:3 [ 0 => "Pallidotomy" 1 => "Parkinson's disease" 2 => "Thalamotomy" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001); sin embargo, las lesiones bilaterales conllevan un alto riesgo de morbilidad.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Matherial and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The following results were obtained by using the UPDRS part III: after pallidotomy “On state” mean: preoperative 51,2, postoperative at 2<span class="elsevierStyleSup">nd</span> day 29,5 at 3, 6 and 9<span class="elsevierStyleSup">th</span> month 26, and at 12<span class="elsevierStyleSup">th</span> month 28,7. “Off state” mean: preoperative 64,3, postoperative at 2<span class="elsevierStyleSup">nd</span> day 31,6, at 3, 6 and 9<span class="elsevierStyleSup">th</span> month 26, and at 12<span class="elsevierStyleSup">th</span> months 30,5. After pallidothalamotomy “On state” mean: preoperative 43,5, postoperative at 2<span class="elsevierStyleSup">nd</span> day 27,9, at 3<span class="elsevierStyleSup">rd</span> month 22,9, at 6<span class="elsevierStyleSup">th</span> month 22,8, and at 9 and 12<span class="elsevierStyleSup">th</span> month 24,5. “Off state” mean: preoperative 62,6, postoperative at 2<span class="elsevierStyleSup">nd</span> day 38, at 3<span class="elsevierStyleSup">rd</span> month 30, at 6<span class="elsevierStyleSup">th</span> month 31,8 and at 9 and 12<span class="elsevierStyleSup">th</span> month 33,8.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001), but bilateral lesioning carried higher surgical morbidity.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Llumiguano, C.; Dóczi, T.; Baths, I.: Tratamiento de la enfermedad de Parkinson con palidotomía y palidotalamotomía estereotáctica guiada por microelectrodos. Neurocirugía 2006; 17: 420–432.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 6 | 3 | 9 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Marzo | 1 | 1 | 2 |
| 2018 Febrero | 25 | 7 | 32 |
| 2018 Enero | 33 | 5 | 38 |
| 2017 Diciembre | 28 | 10 | 38 |
| 2017 Noviembre | 68 | 42 | 110 |
| 2017 Octubre | 39 | 9 | 48 |
| 2017 Septiembre | 31 | 10 | 41 |
| 2017 Agosto | 25 | 8 | 33 |
| 2017 Julio | 28 | 15 | 43 |
| 2017 Junio | 47 | 10 | 57 |
| 2017 Mayo | 45 | 9 | 54 |
| 2017 Abril | 39 | 8 | 47 |
| 2017 Marzo | 21 | 16 | 37 |
| 2017 Febrero | 17 | 10 | 27 |
| 2017 Enero | 9 | 11 | 20 |
| 2016 Diciembre | 21 | 10 | 31 |
| 2016 Noviembre | 32 | 16 | 48 |
| 2016 Octubre | 45 | 27 | 72 |
| 2016 Septiembre | 61 | 39 | 100 |
| 2016 Agosto | 49 | 15 | 64 |
| 2016 Julio | 40 | 32 | 72 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Noviembre | 1 | 0 | 1 |
| 2015 Julio | 1 | 5 | 6 |
| 2015 Junio | 27 | 7 | 34 |
| 2015 Mayo | 36 | 16 | 52 |
| 2015 Abril | 17 | 15 | 32 |
| 2015 Marzo | 22 | 13 | 35 |
| 2015 Febrero | 23 | 15 | 38 |
| 2015 Enero | 26 | 13 | 39 |
| 2014 Diciembre | 35 | 11 | 46 |
| 2014 Noviembre | 26 | 12 | 38 |
| 2014 Octubre | 20 | 17 | 37 |
| 2014 Septiembre | 14 | 17 | 31 |
| 2014 Agosto | 25 | 19 | 44 |
| 2014 Julio | 22 | 15 | 37 |
| 2014 Junio | 24 | 30 | 54 |
| 2014 Mayo | 28 | 20 | 48 |
| 2014 Abril | 22 | 25 | 47 |
| 2014 Marzo | 25 | 35 | 60 |
| 2014 Febrero | 26 | 22 | 48 |
| 2014 Enero | 24 | 23 | 47 |
| 2013 Diciembre | 17 | 18 | 35 |
| 2013 Noviembre | 21 | 38 | 59 |
| 2013 Octubre | 20 | 22 | 42 |
| 2013 Septiembre | 19 | 27 | 46 |
| 2013 Agosto | 26 | 28 | 54 |
| 2013 Julio | 26 | 13 | 39 |
| 2013 Junio | 10 | 15 | 25 |
| 2013 Mayo | 13 | 24 | 37 |
| 2013 Abril | 9 | 12 | 21 |
| 2013 Marzo | 10 | 26 | 36 |
| 2013 Febrero | 10 | 16 | 26 |
| 2013 Enero | 16 | 17 | 33 |
| 2012 Diciembre | 10 | 21 | 31 |
| 2012 Noviembre | 1 | 9 | 10 |
| 2012 Octubre | 0 | 1 | 1 |
| 2012 Septiembre | 0 | 2 | 2 |
| 2012 Enero | 19 | 0 | 19 |
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