Hospital La Fe realiza operación pionera en España en enfermos de Parkinson

Valencia, 6 feb (EFE). Una mujer de 65 años que sufría enfermedad de Parkinson avanzada ha sido sometida en el Hospital La Fe de Valencia a una intervención pionera en España que, mediante la inserción de un electrodo en un zona profunda del cerebro, consigue mejorar síntomas como la rigidez, lentitud de movimientos y temblor.

A la paciente intervenida, Emilia Llinares, le diagnosticaron Parkinson hace 22 años y desde entonces ha estado medicándose para combatir los efectos de esta enfermedad, pero decidió operarse cuando el tratamiento farmacológico no conseguía los efectos esperados.

La intervención fue realizada el 2 de febrero por un equipo multidisciplinar del Hospital Universitari i Politècnic la Fe de Valencia, el primer centro español que ofrece esta técnica, con la que hasta la fecha se han realizado cuatro intervenciones, todas con un resultado "altamente satisfactorio", según fuentes sanitarias.

El jefe de la Unidad de Neurocirugía, Carlos Botella, ha explicado a EFE que la novedad de la intervención consiste en que dentro del quirófano hay un TAC que ofrece imágenes reales y permite la implantación del electrodo, que mide unos 8 milímetros de diámetro, en la zona correcta que se debe estimular.

"Tenemos la seguridad dentro del propio quirófano que la situación del electrodo es la correcta", ha explicado Botella.

La paciente que se ha sometido a la operación "no respondía ya a tratamiento farmacológico", según el facultativo, que ha indicado que lo que se consigue con la estimulación cerebral profunda "es reducir la necesidad de fármacos y poner al paciente en una situación como estaba diez años antes".

Para el Jefe de la Unidad de Neurocirugía de la Fe, esta operación "es una de las intervenciones más agradecidas" debido a que el paciente "es capaz de ser autónomo en la mayor parte de las actividades de la vida diaria".

Esta intervención está indicada únicamente a pacientes "para los que el tratamiento farmacológico ya no es efectivo", algo que suele suceder a los diez años, según el experto.

Por su parte, la neuróloga Irene Martínez ha explicado a EFE que Emilia, antes de operarse, "fluctuaba entre un estado en el que tenía buena movilidad cuando la medicación hacía efecto y unos períodos en los que la movilidad estaba limitada".

"Con la operación lo que vamos a conseguir es una buena situación motora prácticamente todo el día y de manera estable, sin los períodos de bloqueo que estaba teniendo hasta ahora", ha comentado la doctora.

Emilia Llinares, que se encuentra ya en planta donde permanecerá ingresada unos tres o cuatro días más, ha asegurado a EFE que tras la operación ha sentido "mejoría en las piernas, menos rigidez y al andar también, porque el parkinson es muy malo para andar".

La paciente ha comentado que decidió someterse a la operación "porque estaba harta de tanta medicación. Hace 22 años que la tengo y hasta el hígado se resentía".

La mujer se encuentra animada por los resultados y ha señalado que tras esta operación espera "estar mejor y poder salir, porque hay veces que quieres salir pero estás en 'off' y no puedes moverte". Fonte: ABC.es.

Así se "apaga" y se "enciende" un ser humano

Paco Montesinos es un paciente de Parkinson. Hace 8 años le implataron un par de electrodos en el interior de su cerebro con los que consigue superar su rigidez. Cuando el aparato se apaga, para una revisión rutinaria o si sucede por accidente, Paco vuelve al estado en que le deja la enfermedad.

jueves, 02/02/2012 - "Me siento como si fuera una escultura". Frente a nosotros, Paco Montesinos, de 58 años, acaba de quedarse completamente inmóvil y apagado. No puede mover su cuerpo ni los ojos, apenas respira como si se tratara de un ciborg al que han apagado el interruptor. "Os aseguro que no está haciendo teatro", afirma su neuróloga, María José Catalán. Un instante después vuelve a "encenderlo".

Paco tiene enfermedad de Parkinson y hace seis años fue sometido a una operación de implante de electrodos en el cerebro. El dispositivo estimula eléctricamente el núcleo subtalámico y compensa las funciones de la dopamina que su organismo ha dejado de generar. Los pacientes de Parkinson van perdiendo la denominada "sustancia negra" y este cambio genera todo el cuadro de síntomas de la enfermedad, desde la rigidez hasta los conocidos temblores.

La operación no sirve para todos los pacientes ni elimina más síntomas que la medicación. Se aplica en personas que no responden bien al tratamiento y en los que no han funcionado otras vías. Una vez operados, algunos pacientes como Paco, o Carmen, notan una mejoría extraordinaria que dura varios años, aunque en otros casos la mejora es pasajera.

Paco lleva una batería incorporada bajo la piel de su pecho. Su neuróloga le ha facilitado un mando a distancia de bolsillo que le permite "reiniciarse" si el estimulador se apaga por accidente, como ocurriría si pasa bajo el arco de seguridad de un aeropuerto. Periódicamente acude a la consulta para que su médico vuelva a colocar el estimulador en los parámetros correctos, que se van ajustando en función de cómo evolucionen sus síntomas.

Cuando la neuróloga conecta el estimulador de nuevo, Paco parece volver a la vida. Mueve los ojos y se recupera poco a poco del estado de rigidez en que le deja la enfermedad. Después, se levanta de la silla y sonríe. "El estado de la enfermedad es el que habéis visto".

Este vídeo forma parte del documental "El mal del cerebro".

Pincha aquí para ver el documental completo:

Ver documental "El mal del cerebro"

Fonte: La Informacion.es.

Voltagem X Corrente

Research cracking Parkinson’s

MONDAY, JANUARY 30, 2012 | Progress in the fight against Parkinson’s disease has been made in a recent study authored by two University of Cincinnati professors.

This study is the first examining the effectiveness of constant-current stimulation of the brain as a treatment for Parkinson’s symptoms.

The study was co-authored by Dr. Fredy J. Revilla, an associate professor of neurology and UC Health neurologist, and Dr. George Mandybur, an associate professor of neurosurgery, and was published Jan. 11 in the medical journal The Lancet Neurology.

Deep brain stimulation, or DBS, has been proven to reduce the symptoms of Parkinson’s disease and side effects of some medications, such as motor fluctuations and dyskinesia. DBS devices apply voltage to brain tissue, which stimulates the subthalamic nucleus — a lens shaped compact cluster of neurons — found deep in the brain tissue.

 “The purpose of the study was to find a new way of applying stimulation to the brain through these devices,” Revilla said.  “Traditionally the stimulation was done by delivering constant voltage, and this study looked at delivering constant current.”

Constant voltage stimulates brain tissue with a steady voltage, but the current, or rate of application, is not always the same.  On the other hand, constant current applies stimulation at a constant rate, but the voltage may vary.

The Libra and LibraXP, DBS devices manufactured by St. Jude Medical, were examined in the Lancet Neurology study and provide constant-current stimulation.

These devices are not yet available in the U.S., but St. Jude Medical has applied for U.S. Food and Drug Administration approval.  Medtronic — the only company that currently makes DBS devices in the U.S.— has recently added a constant-current feature to compete in the medical innovation market.

“At this point, we know that the constant-current stimulation is at least as effective as the traditional constant-voltage stimulation,” Revilla said. “What is not known yet is if constant-current stimulation is better than constant-voltage.”

Medication for Parkinson’s disease helps reduce the symptoms for a period of time, giving the patient a period of “on time” where symptoms are minimal.  When the medication wears off, the symptoms return and the patient experiences “off time.”

“What the study did was measure the number of hours the patient had in the ‘on’ state, and then after deep brain stimulation with a constant-current device the same number was measured,” said Dr. Revilla.  “What was found is an increase in the number of hours in the ‘on’ state, and as a consequence the patient has a longer period of time every day where they can function closer to normal.” Fonte: News Record.

Presentan un sistema basado en electrodos para combatir el Parkinson

PROMETEDOR AVANCE

22 de enero de 2012 - Los pacientes sometidos al estudio de la Universidad de Florida presentaron una reducción de los síntomas relacionados con la enfermedad y un mayor periodo de tiempo entre los temblores, según los datos de la investigación.

Un equipo médico liderado por la Universidad de Florida presentó un sistema pionero para controlar los síntomas del Parkinson a través de estimulación cerebral basada en pequeñas descargas eléctricas. Los pacientes que recibieron el tratamiento redujeron considerablemente el número de temblores y la duración de los mismos.

"Esta investigación marca una evolución en la tecnología de dispositivos de estimulación cerebral profunda", explicó Michael Okun, líder del proyecto, quien vaticinó que en los próximos cinco o diez años se verá una carrera para mejorar los aparatos que exploren las señales neurales del cerebro.

El sistema está basado en un dispositivo que emite señales eléctricas leves al cerebro a través de unos electrodos. En los resultados obtenidos se apreció un mayor periodo temporal entre cada temblor (4,22 horas frente a la 1,77 registrada previamente), así como movimientos involuntarios más lentos a los habituales.

En la investigación participaron pacientes que sufrían la enfermedad desde hacía cinco años o más y se les siguió por un periodo de un año a partir de la cirugía a las que se les sometió para implantarles los electrodos. "El estudio respalda el uso de corrientes eléctricas leves en las estructuras del cerebro con el objetivo de minimizar los síntomas de la enfermedad de Parkinson", explicó Michael Okun. Fonte: Hechos de Hoy.es.

Sucesso na dbs de caxiense do sul

Bom dia Hugo, tudo bem?

Gostaria que colocasse no blog: http://dbs-parkinson-brasil.blogspot.com/2011/06/caxiense-tenta-cirurgia-para-amenizar.html, que a cirurgia foi realizada no dia 11/10/11, foi um sucesso, meu pai esta retomando a vida novamente, pois antes ele tinha muitos movimentos involuntarios, o que deixava de permitir a ele uma vida social.

Quem realizou a mesma foi Dr Telmo Reis, que atua no Moinhos de Vento em Porto Alegre.

A cirurgia foi concedida através do Estado do RS e do Munícipio de Caxias do Sul.

Agradeço a todos que de alguma forma colaboraram.

Um grande abraço...
crismaltauro@pop.com.br

Subthalamic deep brain stimulation with a constant-current device in Parkinson's disease: an open-label randomised controlled trial

Jan 11, 2012 - Constant-current DBS of the subthalamic nucleus produced significant improvements in good quality on time when compared with a control group without stimulation. Future trials should compare the effects of constant-current DBS with those of voltage-controlled stimulation.

Deep brain stimulation in Parkinson's disease: opening up the race towards better technology

Jan 11, 2012 - In this issue of The Lancet Neurology, Michael Okun and colleagues1 report on a randomised controlled trial of subthalamic neurostimulation for the treatment of advanced Parkinson's disease. The study confirms the marked benefit that deep brain stimulation (DBS) exerts on parkinsonian motor symptoms, and also offers interesting and novel findings about this surgical therapy.

Fonte: The Lancet.

Resultados positivos de cirurgia dbs / tremor essencial

2011-12-17 - Texto em inglês no West Seattle Herald.

Deep brain stimulation for Parkinson's: one woman's journey

A surgically installed "pacemaker" in the brain is helping Karyn Spilberg manage some of the symptoms of the movement disorder Parkinson's disease.

by Karyn Spilberg
30/11/2011 - "Swing those arms!' commanded my friend Debbie as we went for a routine power walk. I looked at my shadow, and noticed that my left arm was hanging and my left foot was dragging. And so began my journey with the Parkinson's – a brain disorder characterised by difficulty performing smooth and controlled movements (segue...) Fonte: ABC.au.

Artigo muito extenso e por isso não traduzido. Um trecho em especial me chamou a atenção: (...) Três semanas depois, eu estava tomando 50 por cento menos medicação do que antes da cirurgia. Eu fui capaz de tomar parte da Parkinson's Unity Walk, um evento de angariação de fundos anual. Eu não tive dificuldade para andar os 4 km, eu não tinha medo de congelamento. O "nevoeiro" em torno de meus olhos tinha levantado, e eu me senti muito bem. (...)

Cirurgia de Parkinson - 08/06/2011 - Wlademir Santana dos Reis

Implantes cerebrais podem ajudar os pacientes psiquiátricos

Brain implants may help psychiatric patients

Operating on psychiatric patients' brains has come a long way from the lobotomies depicted in One Flew Over the Cuckoo's Nest. Picture: AP

November 23, 2011 - DEEP brain stimulation may sound like a scary concept but is emerging as a revolutionary way to treat psychiatric patients.
The therapy, which involves a tiny implant being embedded in the brain, has already had great success in controlling limb tremors in thousands of people with Parkinson's disease.
Scientists in Australia are now working on revamping the electrodes inside the implants to use in people with mental disorders.
But this latest form of psychosurgery is a long way from the days of the notorious lobotomies carried out decades ago which left many psychiatric patients like zombies.
The implants work in a similar way to how cochlear implants help deaf people hear again, by firing off electrical signals to the brain.
The theory is that you can shut down areas causing symptoms related to conditions such as Parkinson's, epilepsy, obsessive compulsive disorder (OCD) and chronic depression.

How the implants are being tested
Professor Hugh McDermott, of the Bionics Institute in Melbourne, helped develop the cochlear implant and has been working on developing the technology for use in blind people and others with movement and psychiatric disorders.
However, he says the implants are not a cure and should only be used in patients with severe conditions who have had no luck with traditional treatments like medication.
"The idea is that electrical stimulation can make neurons in the brain fire, or suppress them from firing. It's a matter of choosing the right neurons to get the right therapeutic benefits," Professor McDermott said.
While 75,000 Parkinson's patients around the world including hundreds in Australia have received brain implants, using the devices in psychiatric patients is still experimental.
For the past few years Professor McDermott has worked with Melbourne neurosurgeon Richard Bittar to test them in a handful of Australian patients.
Three had obsessive compulsive disorder (OCD), one epilepsy and five severe depression.

'Some are more or less completely cured'
Associate Professor Bittar says while it is early days and more needs to be done to improve the implants, the results have been promising.
"I'm very encouraged. I think with this type of technology our results can only get better," he said.
"One lady who was housebound, packed up her bags and went travelling after the surgery. She was over the moon. She still is."
The patients with depression received their implants in the past four years.
Unlike traditional medications whose effects can subside after long periods of use, Associate Professor Bittar has noticed the implants continue to benefit his patients.
For some of the OCD patients the implants have had just as big an impact.
"About half get a dramatic benefit and some are more or less completely cured," said Professor McDermott, who discussed his work at the International Conference on Medical Bionics held on Victoria's Phillip Island.
"They go from institutional care to a relatively normal life where they can have a job and pretty much normal social interactions again.
"It's a miraculous benefit for those people. But it doesn't do that for everybody at the moment."
Epilepsy is proving trickier to treat as seizures associated with the condition start in different parts of the brain and spread, making it hard to work out where to put the implant.
"Epilepsy certainly looks like one of the harder conditions to treat whereas things like OCD and Parkinson's we have a much more well-defined area in the brain to target to give a better result," Associate Professor Bittar said.

Wires run from skull to power pack
While the implants help some patients, the devices are still considered fairly crude.
Surgeons use a hole in the skull to insert the implants in a certain part of the brain, depending on the disorder they wanted to treat.
The implants are connected to a series of wires running from the skull under the skin down the neck to a power pack in the chest or abdomen.
But some patients are unhappy about the rectangular power pack protruding under their skin, while the wires connected to the brain implant sometimes break as a result of normal head and neck movement during the day.
It can also take time to work out the right amount of electrical stimulation needed, and there can be side effects including speech and balance problems.
Scientists including Professor McDermott are aiming to develop wireless versions of the implants similar to the cochlear ones.
And instead of having a battery pack implanted in the chest, a rechargeable battery would sit behind the recipient's ear.

'We don't want to open the floodgates'
Associate Professor Bittar says a slow and careful approach to the development and use of the implants is essential.
"We don't want to open the floodgates for this type of thing," he said.
"It's very important you go about this in a responsible fashion, particularly in view of what happened all those decades ago with the original form of psychosurgery.
"We have all learned the lessons from that era and most of us are very keen on avoiding making the same mistakes again." Fonte: News.au.