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Estimulação cerebral profunda e distonia : experiência do grupo de cirurgia funcional do CHULN-HSM
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Objectivos: caracterizar uma amostra de doentes com distonia submetidos a estimulação cerebral profunda no Globus Pallidus interno (ECP-GPi) e avaliar dados relativos ao procedimento, à sua eficácia e segurança.
Materiais e métodos: foram incluídos todos os doentes submetidos a ECP-GPi entre 2010 e 2019, avaliando as suas características demográficas, nosológicas, coordenadas estereotáxicas, parâmetros de estimulação. Foi avaliado o benefício clínico através da diferença das pontuações de Burke-Fahn-Marsden Dystonia Rating Scale pós- e pré-operatórias e do número de doentes que se manteve sob ECP. Os efeitos adversos (EA) foram agrupados em cirúrgicos, relacionados com o hardware e relacionados com a estimulação, e comparados com o descrito na literatura. Também se correlacionou o tamanho electrofisiológico do GPi com a presença de efeitos piramidais.
Resultados: foram estudados 45 doentes, com média de idade de início da doença de 19,8 ± 21,4 anos, idade na altura da cirurgia de 36,1 ± 19,5 anos e da doença até cirurgia foi 16,2 ± 14,5 anos, havendo mais casos de distonia generalizada (77,8%), mais de distonia isolada (73,3%) e mais casos de distonias adquiridas (51,1%). Avaliou-se um benefício clínico de 45,8% da componente motora e 48,5% na incapacidade, e 88,9% dos doentes manteve-se sob ECP. Houve 71,1% de doentes com EA, com 60% relacionados com estimulação, 17,8% relacionados com hardware (sobretudo disfunção de hardware, 11,1%) e 17,8% cirúrgicos (sobre perioperatórios 15,6%). Não houve correlação significativa entre o tamanho electrofisiológico do GPi e o aparecimento de efeitos piramidais.
Conclusão: o grupo de cirurgia funcional do Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria demonstrou que a ECP-GPi é um procedimento eficaz e seguro na distonia, sendo comparável à literatura e representativo num contexto real e prático. A interpretação dos resultados é dificultada pela variabilidade das definições e classificações de dados associados à ECP na literatura.
Objectives: The aim of this study was to describe a sample of patients with dystonia that underwent pallidal deep brain stimulation (GPi DBS) and to retrospectively assess procedure-related data, stimulation parameters and clinical and safety outcomes. Methods: patients that underwent DBS GPi between 2010 and 2019, evaluating its demographic and nosologic characteristics, stereotactic coordinates, stimulation parameters, its clinical benefit with the baseline and 6-month postoperative Burke-Fahn-Marsden Dystonia Rating Scale scores and the number of patients maintained on DBS GPi. The adverse effects (AE) where evaluated, grouping them into surgical, hardware-related and stimulation-related, comparing them with the literature. The electrophysiological size of GPi was correlated with the presence of pyramidal effects. Results: we studied 45 patients, with mean age of onset 19,8 ± 21,4 years, age on surgery 36,1 ± 19,5 years and follow-up until surgery 16,2 ± 14,5 years, with more cases of generalized dystonia (77,8%), isolated dystonia (73,3%) and acquired dystonia (51,1%). There was a mean motor and disability improvement of 45,8% and 48,5%, respectively, and 88,9% still maintain DBS treatment. AE occurred on 71,1% patients, 60% stimulation-related, 17,8% hardware-related (mostly hardware dysfunction, 11,1%) and 17,8% where surgical (mostly perioperative, 15,6%). There was no correlation between the electrophysiological size of GPi and the appearance of pyramidal effects. Conclusions: the functional surgery group of Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria demonstrated that DBS on GPi is an effective and safe procedure in dystonia patients, being comparable to the literature and representative on a real and practical context. The definition and classification variability of the DBS-related data on the literature limits the interpretation of the results.
Objectives: The aim of this study was to describe a sample of patients with dystonia that underwent pallidal deep brain stimulation (GPi DBS) and to retrospectively assess procedure-related data, stimulation parameters and clinical and safety outcomes. Methods: patients that underwent DBS GPi between 2010 and 2019, evaluating its demographic and nosologic characteristics, stereotactic coordinates, stimulation parameters, its clinical benefit with the baseline and 6-month postoperative Burke-Fahn-Marsden Dystonia Rating Scale scores and the number of patients maintained on DBS GPi. The adverse effects (AE) where evaluated, grouping them into surgical, hardware-related and stimulation-related, comparing them with the literature. The electrophysiological size of GPi was correlated with the presence of pyramidal effects. Results: we studied 45 patients, with mean age of onset 19,8 ± 21,4 years, age on surgery 36,1 ± 19,5 years and follow-up until surgery 16,2 ± 14,5 years, with more cases of generalized dystonia (77,8%), isolated dystonia (73,3%) and acquired dystonia (51,1%). There was a mean motor and disability improvement of 45,8% and 48,5%, respectively, and 88,9% still maintain DBS treatment. AE occurred on 71,1% patients, 60% stimulation-related, 17,8% hardware-related (mostly hardware dysfunction, 11,1%) and 17,8% where surgical (mostly perioperative, 15,6%). There was no correlation between the electrophysiological size of GPi and the appearance of pyramidal effects. Conclusions: the functional surgery group of Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria demonstrated that DBS on GPi is an effective and safe procedure in dystonia patients, being comparable to the literature and representative on a real and practical context. The definition and classification variability of the DBS-related data on the literature limits the interpretation of the results.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Neurocirurgia funcional Distonia Estimulação cerebral profunda Efeitos adversos Neurocirurgia