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2018

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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(06): 411-420
DOI: 10.1590/0004-282X20180048

VIEWS AND REVIEWS

Decisions about deep brain stimulation therapy in Parkinson’s disease

Decisões a respeito da terapia com estimulação cerebral profunda na doença de Parkinson

Pedro Brandão

¹Universidade de Brasília, Laboratório de Neurociência e Comportamento, Brasilia DF, Brasil;

²Câmara dos Deputados, Departamento Médico, Serviço de Neurologia, Brasilia DF, Brasil;

,

Talyta Cortez Grippe

³Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasilia DF, Brasil;

,

Luiz Cláudio Modesto

⁴Hospital de Base do Distrito Federal, Unidade de Neurocirurgia, Brasilia DF, Brasil;

,

André Gustavo Fonseca Ferreira

³Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasilia DF, Brasil;

,

Flávia Martins da Silva

³Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasilia DF, Brasil;

,

Flávio Faria Pereira

³Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasilia DF, Brasil;

,

Marcelo Evangelista Lobo

³Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasilia DF, Brasil;

,

Nasser Allam

¹Universidade de Brasília, Laboratório de Neurociência e Comportamento, Brasilia DF, Brasil;

³Hospital de Base do Distrito Federal, Unidade de Neurologia, Brasilia DF, Brasil;

,

Tiago da Silva Freitas

⁴Hospital de Base do Distrito Federal, Unidade de Neurocirurgia, Brasilia DF, Brasil;

,

Renato P. Munhoz

⁵University of Toronto, Toronto Western Hospital, Movement Disorders Centre, University Health Network, Toronto, Canada.

› Author Affiliations

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ABSTRACT

Parkinson’s disease can be treated surgically in patients who present with motor complications such as fluctuations and dyskinesias, or medically-refractory disabling tremor. In this review, a group of specialists formulated suggestions for a preoperative evaluation protocol after reviewing the literature published up to October 2017. In this protocol, eligibility and ineligibility criteria for surgical treatment were suggested, as well as procedures that should be carried out before the multidisciplinary therapeutic decisions. The review emphasizes the need to establish “DBS teams”, with professionals dedicated specifically to this area. Finally, surgical target selection (subthalamic nucleus or globus pallidus internus) is discussed briefly, weighing the pros and cons of each target.

RESUMO

A doença de Parkinson pode ser tratada cirurgicamente em pacientes que desenvolveram complicações motoras, como flutuações e discinesias, ou tremores refratários ao uso de medicação. Nesta revisão, um grupo de especialistas formulou sugestões para um protocolo de avaliação pré-operatória, depois de revisar a literatura publicada até outubro de 2017. Neste protocolo, são sugeridos critérios de elegibilidade e inadmissibilidade para tratamento cirúrgico, bem como procedimentos que devem ser realizados antes das decisões terapêuticas multidisciplinares. A revisão enfatiza a necessidade de estabelecer “equipes de DBS”, com profissionais dedicados especialmente a esta área. Ao final, a seleção do alvo cirúrgico (núcleo subtalâmico ou globo pálido interno) é discutida brevemente, ponderando prós e contras de cada escolha.

Parkinson disease - deep brain stimulation - reference standards - basal ganglia - neurosurgical procedures

doença de Parkinson - estimulação cerebral profunda - padrões de referência - gânglios da base - procedimentos neurocirúrgicos

Publication History

Received: 08 January 2018

Accepted: 06 March 2018

Article published online:
25 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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