Abordagens de tratamento da doença de Parkinson e seus resultados terapêuticos
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TCC
Data de publicação
2024-11-28
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Autores
Santos, Estevão Cabral
Santos, Vinícius Cabral
Santos, Vinícius Cabral
Orientador
Silva, Ilton Santos da
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A doença de Parkinson é a segunda doença neurodegenerativa mais prevalente no mundo e essa prevalência aumenta com a idade. Os sintomas motores são as principais alterações da doença, como bradicinesia, rigidez, aumento do tônus muscular, alterações de postura, marcha festinante e tremor de repouso, mas também podem surgir alterações cognitivas e em outros sistemas. Para o controle dos sintomas motores existe tratamentos farmacológicos como a levodopa, agonistas dopaminérgicos, MAO-B inibidores e tratamentos cirúrgicos como "deep brain stimulation" (DBS) e talamotomia. Porém, devido ao desenvolvimento de eventos adversos e as diferentes capacidades do controle dos sintomas motores para cada uma das abordagens resulta em uma heterogeneidade de indicações. Objetivos: Analisar as abordagens de tratamento para a doença de Parkinson quanto à capacidade de controle dos sintomas motores. Metodologia: Estudo retrospectivo observacional com dados de prontuários de pacientes com a doença de Parkinson sob qualquer método de tratamento. Os prontuários foram obtidos no hospital Instituto de Neurologia de Curitiba (INC) e são do período 10/02/2016 até 10/02/2023, sendo analisado a presença dos sintomas motores antes do tratamento, 6 meses após o tratamento, até um ano após o tratamento e mais de um ano após o tratamento. Após a seleção por critérios de elegibilidade a amostra foi de 49 pacientes. Foi feita uma estatística descritiva e teste Qui-quadrado. Resultados: Dentre os 49 pacientes avaliados todos realizaram algum tipo de tratamento farmacológico e 47 realizaram algum procedimento cirúrgico. A cirurgia mais realizada foi DBS subtalâmico (DBS STN), com 23 pacientes, seguida da talamotomia, com 11 pacientes. Os sintomas mais prevalentes na primeira admissão foi tremores em 42(84%) pacientes, rigidez em 35 (70%) e bradicinesia em 31 (62%). Discinesias e flutuações motoras foram relatadas em 18 (36%) e 14 (28%) pacientes respectivamente. As médias de idade foram 54,14 no diagnóstico, 64,07 na cirurgia. A média de tempo de doença até a realização da cirurgia foi de 5,22 anos. Todos os pacientes utilizaram algum derivado da levodopa. Houve uma melhora em geral dos sintomas motores em todas as cirurgias, sendo que houve uma diferença significativa entre DBS STN e talamotomia quanto ao controle dos tremores (p=0,009) no período de 6 meses com a talamotomia apresentando um controle melhor do sintoma. Em relação as complicações cirúrgicas, 4 pacientes que realizaram DBS STN tiveram infecção cirúrgica, sendo necessário a remoção do implante do DBS, 7 pacientes tiveram episódios de queda após a cirurgia, 6 deles realizaram DBS STN e 1 talamotomia. Conclusão: O tratamento cirúrgico tem sua importância para complementar o tratamento medicamentoso, visto que reduzem os sintomas motores, como bradicinesia, tremores e rigidez, atenuar os efeitos colaterais dos fármacos, como discinesia e flutuações motoras. Por fim, a decisão de qual procedimento cirúrgico realizar envolve outros fatores além do controle dos sintomas, como custo, bilateralidade dos sintomas, idade do paciente e predisposição para complicações.
Parkinson's disease is the second most prevalent neurodegenerative disease worldwide, and this prevalence increases with age. Motor symptoms are the main alterations in the disease, including bradykinesia, rigicity, increased muscle tone, postural changes, festinating gait, and resting tremor. Cognitive changes and alterations in other systems may also occur. To control motor symptoms, there are pharmacological treatments such as levodopa, dopaminergic agonists, and MAO-B inhibitors, as well as surgical treatments like deep brain stimulation (DBS) and thalamotomy. However, due to the development of adverse events and the different capacities for motor symptom control across these approaches, a heterogeneity of indications arises. Objectives: To analyze treatment approaches for Parkinson's disease in terms of their capacity to control motor symptoms. Methodology: This is a retrospective observational study using medical records of patients with Parkinson's disease undergoing any treatment method. The records were obtained from the Instituto de Neurologia de Curitiba (INC) hospital and span the period from 02/10/2016 to 02/10/2023, analyzing the presence of motor symptoms before treatment, six months after treatment, up to one year after treatment, and more than one year after treatment. After applying eligibility criteria, the sample consisted of 49 patients. Descriptive statistics and Chi-square testing were performed. Results: Among the 49 patients evaluated, all underwent some form of pharmacological treatment, and 47 underwent a surgical procedure. The most performed surgery was subthalamic DBS (DBS STN), with 23 patients, followed by thalamotomy, with 11 patients. The most prevalent symptoms at the first admission were tremors in 42 (84%) patients, rigidity in 35 (70%), and bradykinesia in 31 (62%). Dyskinesias and motor fluctuations were reported in 18 (36%) and 14 (28%) patients, respectively. The average ages were 54.14 at diagnosis and 64.07 at surgery. The average time from disease onset to surgery was 5.22 years. All patients used some form of levodopa derivative. There was an overall improvement in motor symptoms with all surgeries, with a significant difference between DBS STN and thalamotomy in tremor control (p=0.009) in the six-month period, with thalamotomy showing better symptom control. Regarding surgical complications, 4 patients who underwent DBS STN experienced surgical infections, necessitating DBS implant removal, and 7 patients experienced falls post-surgery; 6 of these had undergone DBS STN, and 1 had thalamotomy. Conclusion: Surgical treatment plays an important role in complementing pharmacological treatment, as it reduces motor symptoms such as bradykinesia, tremors, and rigidity and attenuates drug side effects like dyskinesia and motor fluctuations. Ultimately, the decision of which surgical procedure to perform involves factors beyond symptom control, such as cost, symptom laterality, patient age, and predisposition to complications.
Parkinson's disease is the second most prevalent neurodegenerative disease worldwide, and this prevalence increases with age. Motor symptoms are the main alterations in the disease, including bradykinesia, rigicity, increased muscle tone, postural changes, festinating gait, and resting tremor. Cognitive changes and alterations in other systems may also occur. To control motor symptoms, there are pharmacological treatments such as levodopa, dopaminergic agonists, and MAO-B inhibitors, as well as surgical treatments like deep brain stimulation (DBS) and thalamotomy. However, due to the development of adverse events and the different capacities for motor symptom control across these approaches, a heterogeneity of indications arises. Objectives: To analyze treatment approaches for Parkinson's disease in terms of their capacity to control motor symptoms. Methodology: This is a retrospective observational study using medical records of patients with Parkinson's disease undergoing any treatment method. The records were obtained from the Instituto de Neurologia de Curitiba (INC) hospital and span the period from 02/10/2016 to 02/10/2023, analyzing the presence of motor symptoms before treatment, six months after treatment, up to one year after treatment, and more than one year after treatment. After applying eligibility criteria, the sample consisted of 49 patients. Descriptive statistics and Chi-square testing were performed. Results: Among the 49 patients evaluated, all underwent some form of pharmacological treatment, and 47 underwent a surgical procedure. The most performed surgery was subthalamic DBS (DBS STN), with 23 patients, followed by thalamotomy, with 11 patients. The most prevalent symptoms at the first admission were tremors in 42 (84%) patients, rigidity in 35 (70%), and bradykinesia in 31 (62%). Dyskinesias and motor fluctuations were reported in 18 (36%) and 14 (28%) patients, respectively. The average ages were 54.14 at diagnosis and 64.07 at surgery. The average time from disease onset to surgery was 5.22 years. All patients used some form of levodopa derivative. There was an overall improvement in motor symptoms with all surgeries, with a significant difference between DBS STN and thalamotomy in tremor control (p=0.009) in the six-month period, with thalamotomy showing better symptom control. Regarding surgical complications, 4 patients who underwent DBS STN experienced surgical infections, necessitating DBS implant removal, and 7 patients experienced falls post-surgery; 6 of these had undergone DBS STN, and 1 had thalamotomy. Conclusion: Surgical treatment plays an important role in complementing pharmacological treatment, as it reduces motor symptoms such as bradykinesia, tremors, and rigidity and attenuates drug side effects like dyskinesia and motor fluctuations. Ultimately, the decision of which surgical procedure to perform involves factors beyond symptom control, such as cost, symptom laterality, patient age, and predisposition to complications.
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Palavras-chave
doença de Parkinson , palidotomia , estimulação encefálica profunda , radiocirurgia , Parkinson disease , pallidotomy , deep brain stimulation , radiosurgery