Estimulación de la médula espinal para los trastornos de la marcha en Enfermedad de Parkinson y parkinsonismo atípico: Una revisión sistemática de los estudios preclínicos y clínicos: Publicado originalmente en la Revista Neuromodulation 2023; 26: 1339–1361. Traducción: Dr. Sergio Sacchettoni.

Matteo Ciocca; Barry M. Seemungal; Yen F. Tai

doi:10.47924/neurotarget2024454

Autores/as

Matteo Ciocca Departamento de Ciencias del Cerebro, Imperial College London, Londres, Reino Unido.
Barry M. Seemungal Departamento de Ciencias del Cerebro, Imperial College London, Londres, Reino Unido.
Yen F. Tai Departamento de Ciencias del Cerebro, Imperial College London, Londres, Reino Unido.

DOI:

https://doi.org/10.47924/neurotarget2024454

Palabras clave:

Congelación de la marcha, atrofia multisistémica, enfermedad de Parkinson, parálisis supranuclear progresiva, estimulación de la médula espinal

Resumen

Antecedentes: Las caídas abruptas de pacientes con trastornos extrapiramidales, en particular la enfermedad de Parkinson (EP), la atrofia multisistémica (AMS) y la parálisis supranuclear progresiva (PSP), son hitos clave que afectan la calidad de vida de los pacientes, incurriendo en una mayor morbilidad/mortalidad y altos costos de atención médica. Desafortunadamente, la marcha y el equilibrio en los parkinsonianos responden mal a los tratamientos disponibles actualmente. Una observación casual de la mejoría de la marcha y el equilibrio en pacientes con EP, a los que se le implantó un sistema de electromodulación de la médula espinal (EME) por dolor de espalda crónico, despertó el interés en el uso de EME para tratar los trastornos de la marcha en los parkinsonianos.
Objetivos: Revisamos estudios preclínicos y clínicos de la EME para tratar la disfunción de la marcha en parkinsonismos, cubriendo su posible mecanismos y eficacias.
Materiales y Métodos: Se analizaron los estudios preclínicos en modelos animales de EP y estudios clínicos en pacientes con EP, PSP y AMS en los que se incluyeron pacientes que recibieron EME por trastornos de la marcha. Esta evaluación fue en la mejoría clínica en la marcha, en la medición de resultado utilizada, y posible mecanismo de acción.
Resultados: Identificamos 500 referencias, 45 cumplieron con los criterios de selección y se incluyeron en este estudio para su análisis. A pesar de que los resultados en modelos animales son positivos, los resultados en estudios en humanos son inconsistentes.
Conclusiones: La falta de estudios doble-ciegos y con significancia estadística, la heterogeneidad en la selección de pacientes y los resultados de los estudios, y la escasa comprensión de los mecanismos de acción subyacentes de la EME son algunos de los factores limitantes en este campo. El redireccionamiento de estas limitantes nos permitirá sacar conclusiones más confiables sobre los efectos de la EME en la marcha y el equilibrio en pacientes con trastornos extrapiramidales.

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