Estimulação cerebral profunda bilateral dos núcleos subtalâmicos na doença de parkinson: complicações, efeito clínico, impacto na qualidade de vida e suas correlações

Abstract

Parkinson's disease (PD) is the second most frequent neurodegenerative disease and its prevalence increases exponentially with age. In addition to motor aspects such as resting tremor, rigidity, bradykinesia, and later postural instability and gait disorders, patients present a series of non-motor physical, cognitive and emotional symptoms that interfere with functionality and interfere with quality of life. Objectives: To describe the baseline clinical demographics data and the peri- and postoperative complications, to assess clinical effect by the UPDRS Scale, the Schwalb& England Scale and dosereduction in levodopaequivalents;to assess the impact on quality of life by the Summary Index PDQ-39 scale and its dimensionsand to analyse the correlation between the variables in patients submitted to Bilateral Deep Brain Stimulation of Subthalamic Nuclei (DBS-STN) after 12 months. Patients and Methods: We selected 40 patients prospectively submitted to DBS-STN at the FAMERP’s Hospital de Base from May 2010 to May 2014, following inclusion and exclusion criteria based on the CAPSIT-PD protocol. The UPDRS evaluations were performed and all had a preoperative levodopa test with a response higher than 30%. Clinical data was collected from UPDRS, LEDD and, PDQ-39 before and 12 months after surgery. Peri- and postoperative complications were evaluated. Results: We characterized demographically and clinically the sample, described the complications, obtained significant clinical efficacy in all 4 parts of the UPDRS scale, in addition to a reduction of the LEDD of the order of 54.97% (p <0.0001) compatible with previous meta-analysis. Regarding quality of life, we had a significant reduction (p <0.0001) in the Total PDQ-39 and its dimensions except the social support, with Total PDQ-39 improvement of 58.39% above the average described in the literature. The pre-operative levodopa test (PLT) correlated positively with improvement in the PDQ-39 mobility dimension (r = 0.3587, p = 0.0231) and the PLT group> 56% had a Motor Effect and a total PDQ-39 response higher than the PLT group <56%. The Motor Effect was not correlated with the PDQ-39.Total PDQ-39 correlated negatively with UPDRS I PREOP. Conclusions: The data reinforce the importance of the response to levodopa in clinical effects and motor aspects of quality of life after 12 months of ECPB-NST. The improvement of PDQ-39 can not be explained by motor-only aspects because it is negatively correlated with mental state, behavior and emotional state by UPDRS I.