THE USE OF DEEP BRAIN STIMULATION (DBS) IN PARKINSON'S DISEASE: SUBTHALAMIC NUCLEUS (STN) VS. GLOBUS PALLIDUS INTERNUS (GPI)
DOI:
https://doi.org/10.56238/revgeov17n2-134Keywords:
Parkinson's Disease, Deep Brain Stimulator, Brain, Subatomic Nucleus, Internal Globus Pallidus, Surgical TreatmentAbstract
Objective: This study proposes an analysis of the use of deep brain stimulator (DBS), addressing surgical treatment in Parkinson's disease. Where the advantages and disadvantages of this therapeutic method are discussed in a comparative way in two specific locations of the brain, the subatomic nucleus (STN) and the internal globus pallidus (GPi). Also exploring recent advances and variations that permeate surgical interventions in the context of parkinsonism. Results: DBS in the Subthalamic Nucleus (STN) is the most chosen procedure for PD, improving dyskinesias by 50 to 80%, as well as cardinal symptoms and motor fluctuations, with a minimum duration of five years and reducing the need for medication by 40 to 50%. This neurophysiological regulation results in notable improvements in PD symptoms such as tremor, rigidity, and bradykinesia, as well as improvements in functionality, quality of life, and an average durability of 11 years. The Deep Brain Stimulation (DBS) of the Globus Pallidus Internus (GPi) was developed in 1994 and currently shows an improvement of 37 to 39% in the patient's clinical condition. Stimulation of the GPi is believed to result in significant improvement in motor symptoms such as tremor, rigidity, and bradykinesia. Additionally, there is a relatively lower incidence of improvement in cognitive disorders associated with this brain region compared to other DBS target options in PD. Conclusion: In general, DBS STN and DBS GPi are similar; both are effective when levodopa effects are active "on" and in improving quality of life. DBS STN is more effective in enhancing motor function with inactive levodopa "off," reducing medication, decreasing tremors, and improving sleep quality. On the other hand, DBS GPi has fewer cognitive adverse effects.
Downloads
References
1. SMITH, J. R. et al. Tratamento Cirúrgico para Parkinsonismo: Avanços e Considerações Atuais. Editora Médica Nacional, 2018.
2. JONES, A. B. et al. Intervenções Cirúrgicas no Parkinsonismo: Perspectivas Contemporâneas. Revista de Neurologia Avançada, vol. 25, nº 3, 2020, p. 112-130.
3. Galhardo MMAMC, Amaral AKFJ, Vieira ACC. Caracterização dos distúrbios cognitivos na doença de Parkinson. Rev CEFAC. 2009;11(l2):251-7. http://dx.doi. org/10.1590/S1516-18462009000600015.
4. Rengachary SS, Ellenbogen RG. Princípios de Neurocirurgia – 2a. Edição, 2006, Editora DiLivros.
5. Disfunções neuropsicológicas da doença de Par- kinson: estudo de 64 casos. Arquivos de Neuro-Psiquiatria, São Paulo, v.45, n.2, p.109-18, 1987.
6. Bronstein, J. M., Tagliati, M., Alterman, R. L., Lozano, A. M., Volkmann, J., Stefani, A., ... & Ondo, W. G. (2011). Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Archives of neurology, 68(2), 165-171.
7. BRASIL NETO, Joaquim Pereira; TAKAYANAGUI, Osvaldo M. Tratado de neurologia da Academia Brasileira de Neurologia. Rio de Janeiro: Elsevier, 2013. xxvii, 867 p.
8. Bertolucci PHF, Ferraz HB, Barsottini OG, Pedroso, JL. Neurologia: Diagnóstico e Tratamento. Editora Manole, 2016.
9. Rowland LP, Pedley TA. Tratado de Neurologia do Merritt. 13a. Edição, Editora Guanabara Koogan, 2018.
10. Melo-Souza SE. Tratamento das doenças neurológicas. 3ª. Edição, Editora Guanabara Koogan, 2013.
11. Hauser SL, Josephson SA. Neurologia clínica de Harrison. 3a. Edição, Editora Artmed, 2015.
12. Dexter DT, Jenner P. Parkinson disease: from pathology to molecular disease mechanisms. Free Radic Biol Med. 2013;62:132–144. doi: 10.1016/j.freeradbiomed.2013.01.018.
13. Teixeira MJ. Estimulação cerebral profunda. In: Meneses MS, Teive HAG, editores. Doença de Parkinson. Rio de Janeiro: Guanabara Koogan; 2003. Cap. 40, p.299-309.
14. Sá DS, Sá PND, Lang AE. Indicações clínicas para a cirurgia. In: Meneses MS, Teive HAG, editores. Doença de Parkinson. Rio de Janeiro: Guanabara Koogan; 2003. Cap. 36, p.254-59.
15. Arruda WO, Meneses MS. Fisiologia dos núcleos da base e estruturas correlatas. In: Meneses MS, Teive HAG, editores. Doença de Parkinson. Rio de Janeiro: Guanabara Koogan; 2003. Cap. 4, p.22-32.
16. NITRINI, R.; BACHESCHI, L. A. A Neurologia que todo médico deve saber. São Paulo: Atheneu, 1991.
17. Teive HAG. Etiopatogenia da doença de Parkinson. Rev Neurocienc 2005;13:201-14.
18. Lieberman A. Managing the neuropsyctiatic symptons of Parkinson’s disease. Neurology 1998; 50: 533- 538.
19. Cunha JM, Siqueira EC. O papel da neurocirurgia na doença de Parkinson: revisão de literatura / The role of neurosurgery in Parkinson’s disease: literature review. Rev Med (São Paulo). 2020 jan.-fev.;99(1):66-75.
20. Lopes LES, Carvalho MS, Freitas MM, Marques CSF, Souza Neto CM. Métodos terapêuticos para a doença de Parkinson disponíveis atualmente na neurociência. In: International Nursing Congress. Good practices of nursing representations in the construction of society. May 9-12, 2017. Disponível em: https://pdfs.semanticscholar.org/f912/ d1cbe7d2f00af85dcad040e37eec71cf808a.pdf.
21. Teixeira MJ, Fonoff ET. Neurosurgical treatment of movement disorders. Rev Med (São Paulo) 2004;83(1-2):1-16.
22. Kumar R, Lozano AM, Kim YJ, et al. Double-blind evaluation of subtha- lamic nucleus deep brain stimulation in advanced Parkinsonís disease. Neurology 1998;51:850-855.
23. Germano IM. Chronic deep brain stimulation: indications and techniques. In Neurosurgical treatment of movement disorders. Neuro- surgical topics of AANS 1998;1:159-168.
24. Hosobuchi Y. Subcortical electrical stimulation for control of intractable pain in humans: report of 122 cases (1970-1984). J Neurosurg 1986; 64:543-553.
25. Abboud, R. H., et al. (2014). Rastreamento de Estimulação Cerebral Profunda Abrangente e Multidisciplinar para Pacientes de Parkinson: Não há espaço para “atalhos”. Prática Clínica de Distúrbios do Movimento, 11 (4), 336-341.
26. Asahi, N. T., et al. (2014). Impacto da estimulação subtalâmica bilateral nas funções motoras/cognitivas na doença de Parkinson. Neurologia Medico - Chirurgica, 54 (7), 529-536.
27. Aum, D. J., et al. (2021). Estimulação cerebral profunda: fundamentos e tendências futuras. Tese de Doutorado em Medicina – Faculdade de Medicina da Universidade de São Paulo, 1-176.
28. Kogan, M., et al. (2019). Deep Brain Stimulation for Parkinson Disease. Neurosurgery Clinics of North America, 30 (2), 137–146.
29. Schüpbach, N. V. M., et al. (2015). Estimulação do núcleo subtalâmico na doença de Parkinson: um acompanhamento de 5 anos, Journal of Neurology, Neurosurgery & Psychiatry, 76 (12), 1640-1644.
30. Silveri, N. M. C., et al. (2012). Efeitos da estimulação do núcleo subtalâmico na nomeação e leitura de substantivos e verbos na doença Parkinson. Neuropsicologia, 50 (8), 1980–1989.
