Ventajas de Combinar la Subtalamotomía Dorsolateral y la Tractotomía Pálido-Talámica en la Enfermedad de Parkinson Avanzada: Nota Técnica

Boris Zurita-Cueva; Fidel Zambrano Villamar; Jaime Tapia Velásquez

doi:10.47924/neurotarget2011288

Autores/as

Boris Zurita-Cueva Unidad de Neurocirugía, Omni-Hospital Guayaquil, Ecuador.
Fidel Zambrano Villamar Unidad de Neurocirugía, Omni-Hospital Guayaquil, Ecuador.
Jaime Tapia Velásquez Unidad de Neurocirugía, Omni-Hospital Guayaquil, Ecuador.

DOI:

https://doi.org/10.47924/neurotarget2011288

Palabras clave:

Subtalamotomía, campotomía de Forel, estimulación cerebral profunda

Resumen

Veinte pacientes con enfermedad de Parkinson avanzada fueron tratados quirúrgicamente con subtalamotomía dorsolateral combinada con tractotomía palidotalámica, también llamada campotomía de Forel. Evaluamos la evolución posoperatoria en la primera semana y a los 12 meses. Existió una reducción significativa en la escala UPDRS III en el periodo "off" (66-17) (47%) y en el on (50-7) (47.6%) al año de ser reevaluados los pacientes. La mejoría fue principalmente en las extremidades contralaterales a la lesión y en la musculatura axial. Existió una reducción de la dosis de levodopa a la mitad, y las disquinesias por levodopa mejoraron en un 60%. Una mejoría de 50% en la escala de Schwab & England al año de operados, indicaba que los pacientes pasaron de estar incapacitados, a una vida parcialmente independiente en sus actividades de vida diaria. A pesar que la estimulación profunda del núcleo subtalámico es la técnica quirúrgica más usada actualmente, una microlesión combinada de estos dos blancos antes mencionados ofrece una alternativa segura en algunos pacientes con enfermedad de Parkinson avanzada.

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Limousin P, Pollack P, Benazzouz A, Hoffman D, Le Bas JF, Broussole E, Perret JE, Benabid AL. Effect of Parkinsonian signs and symptoms on bilateral subthalamic stimulation. Lancet 1995; Jan 14; 345(8942): 91-95.

Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffman D, Benabid AL. Electrical stimulation of the subthalamic nucleus in advanced Parkinson s Disease. N Engl J Med 1998; 339: 105-11.

Andy OJ, Jurko MF, Sias FR,. Subthalamotomy in treatment of Parkinsonian tremor. JNeurosurg 1963;20 :860-70.

Su PC, Tseng HM, Liu HM, Yen RF, Liou HH. Subthalamotomy for advanced Parkinson s Disease. J Neurosurg 2002; 97: 598-606.

Celis de la Rosa A: Pruebas No-Paramétricas pág.. 203-219. En: Bioestadística. 2004, Editorial Manual Moderno SA de CV, México D.F.

Zurita-Cueva B, Villamar ZF, Cornejo P, Bedoya C, Altamirano J. Haz Prerrúbrico de Papez y Zona incerta caudal en la enfermedad de Parkinson. Neurotarget 2009; 4 (3): 41-50.

Zurita-Cueva B, Villamar F, Guerrero P, Bedoya C, Cornejo P. Palido Ansotomía Lenticular: Un blanco quirúrgico efectivo en la enfermedad de Parkinson. Revist Ecuato Neurol 2007;(3): 16.

Aufenberg C, Sarthein J, Morel A, Rouson B, Gallay M, Jeanmonod D. A revival of Spiegels Campotomy: Long term results of stereotactic pallidothalamic tractotomy against the parkinsonian thalamocortical dysrhytmia. Thalamus /& related systems 2005; 3 (2): 121-132.

Gallay MN, Jeanmonod D, Liu J, Morel A. Human Pallidothalamic and cerebellothalamic tracts: Anatomical basis for functional stereotactic Neurosurgery. Brain Struct Funct 2008; 212: 443-463.

Peppe A, Pierantozi M, Bassi A, Altibrandi MG, Brusa L, Stefani A, Stanzione P, Mazzone P. Stimulation of the subthalamic nucleus compared with the globus pallidus internus in patients with Parkinson s Disease. J Neurosurg 2004; 101(2): 195-200.

Hamani C, Dostrovsky JO, Lozano AM. The motor thalamus in neurosurgery. Neurosurg 2006; 58: 146-158.

Ilinsky IA, Ilinsky K. Motor thalamic circuits in primate with emphasis on the area targeted in the treatment of movement disorders. Mov Disor 2002; 17(3): S9-14.

Chastan N, Wetby G, Yelnik J, Bardinet E, Do MC, Agid Y, Welter ML. Effect of Nigral stimulation on locomotion and postural stability in patients with Parkinson s disease. Brain 2009; 132: 172-184.

Whichman T, Klien MA. Neuronal activity in primate Substantia nigra pars reticulate during the performance of simple and memory guided elbow movements. J Neurophisiol 2004; 91: 815-827.

Basso MA, Wurst RH. Neuronal activity in the Substatia Nigra pars reticulate during target selection. Journal of Neuroscience 2002; 22 (5) 1883-1894.

Tanibuchi I, Kitano H, Jinnai K. Substatia Nigra output to the prefrontal cortex via thalamus in monkeys. I. Electrophysiological identification of thalamic relay neurons. J Neurophisiol 2009; 102: 2933-2945.

Vilela Filho O, Jóse da Silva D. Unilateral Subthalamic nucleus lesioning. A safe and effective treatment of Parkinson s disesase. Arch Neuropsichiatr 2002; 60 (4): 935-948.

Nishikawa Y, Kobayashi K, Oshima H, Fukaya C, Yamamoto T, Katayama Y, Ogawa A, Ogasawara K. Direct release of levodopa induced dyskinesia by stimulation in the area above the subthalamic nucleus in a patients with Parkinson s disease. Neurol Med Chirur (Tokyo) 2010; 50: 257-259.

Pinto S, Gentil M, Fraix V, Benabid AL, Pollak P. Bilateral subthalamic stimulation effects on oral force control in Parkinson s disease. J Neurol 2003; 250: 179-187.

Gentil M, Pinto S, Pollak P, Benabid Al. Effect of bilateral stimulation of the subthalamic nucleus on parkinsonian dysarthria. Brain & Lenguage 2003; 85: 190-196.

Liotty M, Ramig LO, Vogel D, Cook CI, Ingham RJ,Ingham JC, Fox PT. Hypophonia in Parkinson s disease. Neural correlates of voice treatment revealed by PET. Neurology 2003; 60: 432-440.

Siegel KL, Lohmann K, Metman LV. Effects of bilateral posteroventral pallidotomy on gate of subjects with Parkinson´ s disease. Arch Neurol 2000; 57 : 198-204.

Samuel M, Ceballos Bauman O, Turjanski M et al. Pallidotomy in Parkinson s disease increases supplementary motor area and prefrontal activation during performance of volitional movements. An H2 15O PET study. Brain 1997; 120: 1301-1313.

Obeso JA, Jahanshahi M, Alvarez L, et al. What a man can do without basal ganglia output. The effect of combined unilateral subthalamotomy and pallidotomy in a patient with Parkinson s disease. Experimental Neurol 2009; 220: 283-292.

Mallet L, Schupbach M, Ndiaye K, et al. Stimulation of subterritories of subthalamic nucleus reveals its role in the integration of emotional and motor aspects of behavior. Proc Natl Acad Sci Usa. 2007; 104: 1061-6.

Uemura A, Oka Y, Ohkita K, Yamawaki T, Yamada K. Effect of subthalamic deep brain stimulation on postural abnormality in Parkinson s disease. J Neurosurg 2010; 112: 1283-1288.

Eusebio A, Brown P. Synchronizatioin in the beta frequency band –The bad boy of Parkinsonism or an innocent bystander? Exp Neurol 2009 (mayo); 217(1): 1-3.

Weinberger M, Hutchinson WD, Lozano AM, Hodaie M, Dostrosky JO. Increased gamma oscillatoty activity in the subthalamic nucleus during tremor in Parkinson s disease patients. J Neurophysiol 2009; 101: 789-802.

Kuhn AA, Williams D, Kupsch A, Limousin P, Hariz M, Schneider G, Yarrow K, Brown P. Event-related beta desynchronization in human subthalamic nucleus correlates with motor performance. Brain 2004; 127: 735-746.

Wilcox RA, Cole MH, Wong D, Coyne T, Silburn P, Kerr G. Pedunculopontine nucleus deep brain stimulation produces substain improvement in primary progressive freezing of gait. J Neurol Neurosurg Psichiatr 2011; 82:1256- 1259.

Steffani A, Lozano AM, Peppe A, Stanzione P, Galati S, Tropepi D, Pierantozzi M,Brusa L, Scarnati E, Mazzone P. Bilateral deep brain stimulation of the pedunculopontine and subthalamic nucleus in severe Parkinson s disease. Brain 2007; 130: 1596-1607.

Su PC, Ma Y, Fukuda M, et al: Metabolic changes following subthalamotomy for advanced Parkinsons disease. Ann Neurol 2001; 50: 514-520.

Lopez Flores G, Fernandez R, Alvarez LL, Macias R, Alvarez E, Maragoto C, Teijeiro A, Morales JM, Bouza W, Cruz O, Fermin CE, Jordan J, Palmero R, Vitek CJ, Juncos J, Obeso JA. Subtalamotomía selectiva en la enfermedad de Parkinson. Implementación y validación del método de lesión. Rev Mex Neuroci 2003; 4 (4): 213-226.

Theodosopoulos PV, Marks WG, Chadwick C, Starr P. Locations of movements related cells in the human subthalamic nucleus in Parkinson s Disease. Mov Disord 2003; 18 (7): 791- 798.

Patel NK. Heywood P, O Suliman K, Mc Carter R, Love S, Gill SS. Unilateral subthalamotomy in the treatment of Parkinsons disease. Brain 2003; 126: 1136 -1145.

Alvarez L, Macias R, Pavon N, et al. Therapeutic efficacy of unilateral subthalamotomy in Parkinson s disease: Results in 89 patients followed up for 36 months. J Neurol Neurosurg Psychiatry. 2009; 80: 979-985.

Hernando Requejo V, Pastor J, Peña E, Carrasco-Moro R, Pedroza Sánchez M, Pulido Rivas P, Sola RG. Estimulación subtalámica unilateral en el tratamiento de la enfermedad de Parkinson Avanzada. Rev Neurol 2008; 46: 18-23.

Patel NK, Plaha P, Osulivan K, et al. MRI directed bilateral stimulation of the subthalamic nucleus in patients with Parkinson s disease. J Neurol Neurosurg Psychiatry 2003; 74: 1631- 1637.

Gorgulho A, Schields DC, Malkasian D, Behnke E, Desalles A. Stereotactic coordinates associated with facial musculature contraction during high frequency stimulation of the subthalamic nucleus. Clinical Article. J Neurosurg 2009; 110: 1317-1321.

Rogano LA, Assis M, Teixeira MJ. Sindrome de Horner apos de cirurgia estereotaxica para doenca de Parkinson. Arq Neuro-Psiquiatr 2003; 61(2): 248-249.

Leckman JF, De Lotbiniere AJ, Marek K, Gracco C, Scahill L, Cohen DJ. Severe disturbances in speech, Swallowing and gait following stereotactic infrathalamic lesions in Gilles de la Torettes syndrome. Neurology 1993; 43: 890-894.

Kimber TE, Brophy BP, Thompson PD. Ataxic arm movements after thalamotomy for parkinsonian tremor. J Neurol Neurosurg psychiatry 2003; 74: 258-259.

Merello M, Tenca E, Pérez Lloret S, Martín ME, Bruno V, Cavana S, Antico J, Cerquetti D, Leiguarda R. Prospective ramdomized 1 year followed up comparison of bilateral subthalamotomy versus bilateral subthalamic stimulation and the combination of both in Parkinson s disease patients. Pilot study. Br J Neurosurg 2008; Jun 22(3): 415-22.

Tarsy D. Does subthalamotomy has a place in the treatment of Parkinson s disease? Editorial commentary. J Neurol Neurosurg Psychiatry.2009; Sep;80(9):939-40.

Kumar R, Lozano AM, Sime E, et al: Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation. Neurology 1999; 53: 561-566.