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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2019; 38(02): 124-127
DOI: 10.1055/s-0039-1685151
Case Report | Relato de Caso
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Deep Brain Stimulation for the Treatment of Juvenile Parkinsonism: Case Report

Estimulação cerebral profunda no tratamento do parkinsonismo juvenil: relato de caso
Oliveiros de Oliveira e Silva Neto
1   School of Medical, Pharmaceutical, and Biomedical Sciences, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
,
Adailson Soares de Sousa
1   School of Medical, Pharmaceutical, and Biomedical Sciences, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
,
Ledismar José da Silva 
1   School of Medical, Pharmaceutical, and Biomedical Sciences, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
› Institutsangaben
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Publikationsverlauf

20. Juni 2018

19. Februar 2019

Publikationsdatum:
08. April 2019 (online)

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Abstract

Juvenile parkinsonism (JP) is characterized by the clinical manifestation of Parkinson syndrome before the age of 21 years old. This entity is often associated with genetic mutations. After all the possibilities of clinical treatment have been exhausted, surgical treatment is recommended, performed via deep brain stimulation (DBS) in the subthalamic nucleus (STN) or in the internal segment of the globus pallidus (GPi). The present study aimed to report the case of a patient with JP who underwent DBS in the STN with good clinical response. Neuromodulation via DBS is an option for the treatment of JP. However, since this entity is very rare, and even more peculiar when treated surgically, more studies are necessary to evaluate DBS used to control refractory manifestations and levodopa-induced dyskinesia, as well as surgical complications that may occur, aiming to gather more knowledge of the surgical management of JP. Despite the dysarthria after the DBS, the patient presented a satisfactory response regarding the symptoms, corroborated by the Parkinson's Disease Questionnaire (PDQ-39) score, which was 61.19% before the procedure, and decreased to 21.05% 14 months after the DBS.

Resumo

O parkinsonismo juvenil (PJ) é caracterizado pela manifestação clínica da síndrome de Parkinson antes dos 21 anos de idade. Esta entidade está frequentemente associada a mutações genéticas. Depois de esgotadas todas as possibilidades de tratamento clínico, institui-se o tratamento cirúrgico, que é realizado via estimulação cerebral profunda (ECP) no núcleo subtalâmico (NST) ou no globo pálido interno (GPi). O presente trabalho teve como objetivo relatar o caso de um paciente com PJ que foi submetido à ECP no NST com boa resposta clínica. A neuromodulação via ECP apresenta-se como uma opção de tratamento para o PJ. Contudo, em decorrência da raridade desta entidade, que se torna ainda mais peculiar quando abordada cirurgicamente, são necessários mais estudos que avaliem a ECP utilizada para controlar as manifestações refratárias e a discinesia induzida por levodopa, assim como as complicações cirúrgicas que podem ocorrer, com o intuito de propiciar maior conhecimento sobre o manejo cirúrgico do PJ. Apesar da disartria apresentada após a ECP, o paciente teve resposta satisfatória em relação aos sintomas, o que foi corroborado pela pontuação na escala Parkinson's Disease Questionnaire (PDQ-39), que era 61,19% antes do procedimento e, 14 meses após a ECP, diminuiu para 21,05%.

Keywords

juvenile parkisonism - deep brain stimulation - subthalamic nucleus - neurosurgery - dysarthria

Palavras-chave

parkinsonismo juvenil - estimulação cerebral profunda - núcleo subtalâmico - neurocirurgia - disartria
 

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