RESUMEN
Introducción: Diferentes técnicas quirúrgicas representan una alternativa para el tratamiento de la enfermedad de Parkinson avanzada (EP). El gran desarrollo en las últimas décadas de modernas técnicas de imágenes sumado a los avances del registro neurofisiológico nos permiten localizar y generar lesiones en forma precisa, con bajo número de complicaciones y excelentes resultados funcionales.
Objetivo: Describir los resultados motores obtenidos a los 12 meses post-operatorios de pacientes con diagnóstico de EP avanzada sometidos a subtalamotomía bilateral diferida guiada por microrregistro.
Material y Métodos: Se seleccionaron 9 pacientes con diagnóstico de EP avanzada de acuerdo a los criterios de la United Kingdom Parkinson´s Disease Brain Bank, evaluando los efectos de la subtalamotomía bilateral en dos tiempos quirúrgicos.
Resultados: Una marcada mejoría de los síntomas cardinales como rigidez, bradicinesia y temblor se observó en todos los pacientes, fundamentalmente en la condición de “off”, y en menor medida también en condición “on”. Se destaca un significativo control de las fluctuaciones motoras y discinesias.
Conclusión: La subtalamotomía bilateral diferida guiada por microregistro es un método útil y efectivo en el tratamiento de los síntomas motores de la Enfermedad de Parkinson.

Palabras Clave: Enfermedad de Parkinson; Subtalamotomía; Microrregistro

ABSTRACT
Introduction: In the treatment of advanced Parkinson´s disease (PD) there are different surgical techniques that represent a valid alternative. The development of modern images techniques and neurofisiological recording allow us to generate accurate lesions, with low complications and excellent functional results.
Objective: Describe motor results 12 months post-surgical of patients with advanced PD submitted to bilateral and deferred subthalamotomy guided by microrecording.
Material and Methods: We selected 9 patients with advanced PD diagnosis in concordance with United Kingdom Parkinson`s Disease Brain Bank criteria, evaluating the effects of bilateral subthalamotomy in two different surgical steps.
Results: A marked improvement of cardinal symptoms such as rigidity, bradykinesia and tremor was observed in all patients, fundamentally in “off” condition, and lesser extent in “on” condition. We highlighted a significant control of motor fluctuations and dyskinesias.
Conclusion: Bilateral and deferred suthalamotomy guided by microrecording is an effective and useful method in treatment of cardinal motor symptoms of PD.

Key words: Parkinson`s Disease; Subthalamotomy; Microrecording

]]> BIBLIOGRAFÍA

  1. Hughes AJ, Daniel SE, Blankson S. A Clinicopathological study of 100 cases of Parkinson´s disease. J Neurol Neurosurg Psychiatry 1992; 55:181-4.
  2. Goetz CG, Nutt JG, Stebbins GT. The Unified Dyskinesia Rating Scale: presentation and clinimetric profile. Mov Disord. 2008 Dec 15;23(16):2398-403.
  3. Sergio Pampin, Santiago Driollet Laspiur, Fernando Leiguarda, Juan Pablo Travi, Dario Adamec. Subtalamotomía por Radiofrecuencia: Aspectos Técnico-Quirúrgicos. REV ARGENT NEUROC VOL. 27, Nº 2: 67-71. 2013.
  4. Jourdain VA, Schechtmann G, Di Paolo T. Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action. J Neurosurg. 2014 Jan; 120 (1): 140-51.
  5. Deligny C, Drapier S, Verin M, Lajat Y, Raoul S, Damier P. Bilateral subthalamotomy through DBS electrodes: a rescue option for device-related infection. Neurology 73: 1243-1244. 2009.
  6. Hirashima Y, Ikeda H, Asahi T, Shibata T, Noguchi K, Shima F, et al. Mechanical injury of the subthalamic area during stereotactic surgery followed by improvement of trunk, neck, and face tremor- case report. Neurol Med Chir (Tokyo) 45:484-486, 2005.
  7. Keep MF, Mastrofrancesco L, Erdman D, Murphy B, Ashby LS. Gamma Knife subthalamotomy for Parkinson disease: the subthalamic nucleus as a new radiosurgical target. Case report. J Neurosurgery 97 (5 suppl): 592-599, 2002.
  8. Obeso JA, Jahanshashi M. Alvarez L, Macias R. Pedroso I, Wilkinson L, et al. What can man do without basal ganglia motor output? The effect of combined unilateral subthalamotomy and pallidotomy in a patient with Parkinson´s desease. Exp Neurol 220: 283-292, 2009.
  9. Alvarez L, Macias R, Lopez G, Alvarez E, Pavon N, Rodriguez-Oroz M.C, Juncos J, Maragoto C, Guridi J, Litvan I, Tolosa E, Koller W, Vitek J, DeLong MR, Obeso J.A. Bilateral subthalamotomy in Parkinson’s disease:initial and long-term response. Brain (2005), 128, 570–583.
  10. Tseng HM, Su PC, Liu HM, Liou HH, Yen RF. Bilateral subthalamotomy for advanced Parkinson disease. Surg Neurol. 2007;68 Suppl 1:S43-50; discussion S50-1.
  11. Su PC, Tseng HM, Liu HM, Yen RF, Liou HH. Subthalamotomy for advanced Parkinson disease. J. Neurosurgery 2001/2, 67: 598-606.
  12. Vilela F, da Silva DJ. Unilateral subhtalamic nucleus lesioning: a safe and effective treatment for
  13. Parkinson’s disease. Arq Neuropsiquiatr. 2002; 60: 935–48.
    Patel NK, Heywood P, O’Sullivan K, McCarter R, Love S, Gill SS. Unilateral subthalamotomy in the treatment of Parkinson’s disease. Brain 2003; 126: 1136–45.
  14. Tseng HM, Su PC, Liu HM, Liou HH, Yen RF. Bilateral subthalamotomy for advanced Parkinson disease. Surg Neurol. 2007;68 Suppl 1:S43-50; discussion S50-1.
  15. Alvarez L, Macias R, Pavon N, Lopez G, Rodriguez-Oroz MC, Rodriguez R, et al. Therapeutic efficacy of unilateral subthalamotomy in Parkinson´s disease: results in 89 patients followed for up to 36 months. J Neurol Neurosurg Psychiatry 80:979-985, 2009.
  16. Merello M, Tenca E, Pérez Lloret S, Martín ME, Bruno V, Cavanagh S, Antico J, Cerquetti D, Leiguarda R. Prospective randomized 1-year follow-up comparison of bilateral subthalamotomy versus bilateral subthalamic stimulation and the combination of both in Parkinson's disease patients: a pilot study.Br J Neurosurg. 2008 Jun;22(3):415-22.
  17. Krack P, Limousin P, Benabid AL, Pollak P. Chronic stimulation of subthalamic nucleus improves levodopa-induced dyskinesias in Parkinson´s disease. Lancet 350: 1676, 1997.
  18. Obeso JA, Rodriguez MC, Guridi J, Alvarez L, Alvarez E, Macias R, et al. Lesion of the basal ganglia and surgery for Parkinson disease. Arch Neurol 2001b; 58: 1165–6.
  19. Alvarez L, Macias R, Guridi J, Lopez G, Alvarez E, Maragoto CT, et al. Dorsal subthalamotomy for Parkinson’s disease. Mov Disord. 2001; 16: 72–8.
  20. Rodriguez MC, Guridi OJ, Alvarez L, Mewes K, Macias R, Vitek J, DeLong MR, Obeso JA. The subthalamic nucleus and tremor in Parkinson's disease. Mov Disord. 1998;13 Suppl 3:111-8.
  21. Gill SS, Heywood P .Bilateral dorsolateral subthalamotomy for advanced Parkinson’s disease. The Lancet. Vol 350. Octubre 25, 1997.
  22. Molinuevo JL, Valldeoriola F, Tolosa E, Rumia` J, Valls-Sole´ J, Rolda´n H, Ferrer E. Levodopa withdrawal after bilateral subthalamic nucleus stimulation in advanced Parkinson disease. Arch Neurol 2000; 57: 983–8.
  23. Lozano AM. The subthalamic nucleus: myth and opportunities. Mov. Disord 2001; 16: 183-4.
  24. Vilela Filho O, Silva DJ, Souza HA, Cavalcante JE, Sousa JT, Ferraz FP, Silva LG, Santos LF. Stereotactic subthalamic nucleus lesioning for the treatment of Parkinson's disease. Stereotact Funct Neurosurg. 2001;77(1-4):79-86.
  25. Chen CC, Lee ST, Wu T, Chen CJ, Huang CC, Lu CS. Mov Disord. Hemiballism after subthalamotomy in patients with Parkinson's disease: report of 2 cases. 2002 Nov; 17(6):1367-71.
  26. Doshi P, Bhatt M. Hemiballism during subthalamic nucleus lesioning. Mov Disord 17:848-849, 2002.
  27. Benabid AL, Benazzouz A, Limousin P, Koudsie A, Krack P, Piallat B, Pollak P. Dyskinesias and the subthalamic nucleus. Ann Neurol. 2000 Apr;47 (4 Suppl 1):S189-92.
  28. Guridi J, Obeso JA. The subthalamic nucleus, hemiballismus and Parkinson's disease: reappraisal of a neurosurgical dogma. Brain. 2001 Jan;124(Pt 1):5-19.
  29. Bickel S, Alvarez L, Macias R, Pavon N, Leon M, Fernandez C, Houghton DJ, Salazar S, Rodríguez-Oroz MC, Juncos J, Guridi J, Delong M, Obeso JA, Litvan I. Cognitive and neuropsychiatric effects of subthalamotomy for Parkinson's disease. Parkinsonism Relat Disord. 2010 Sep;16(8):535-9.
  30. Su PC, Tseng HM, Liou HH. Postural asymmetries following unilateral subthalomotomy for advanced Parkinson's disease. Mov Disord. 2002 Jan;17(1):191-4.
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