Dados do Trabalho

Título

Palidotomy in Parkinson's surgery: is there still a place?

RESUMO

Case presentation: Patient, 48 years old, female, resident and born in Ibiara-PB, presented in 2011 symptoms of
movement disorder with tremor at rest in the right upper limb, being diagnosed with Parkinson's Disease (PD). In 2020, she had worsening symptoms with disabling dyskinesias due to levodopa therapy. Pallidotomy was indicated with instant improvement of symptoms and no side effects.Discussion: PD is a chronic, progressive and degenerative disease of the Central Nervous System (CNS), with different clinical manifestations, resulting from the deficit in the production of dopamine by the neurons of the substantia nigra. The most effective pharmacological therapy is with levodopa, aimed at maintaining normal levels of dopamine in the CNS. However, its long-term use can cause adverse effects, such as fluctuations in motor response and the development of involuntary movements, classified as levodopa-induced dyskinesia. Currently, two surgical methods are used for the treatment of dyskinesia: pallidotomy with ablation of the internal globus pallidus and deep brain stimulation (DBS), the latter being the most used because neuromodulation is reversible and adjustable. However, the choice of method must be based on careful clinical analysis and socioeconomic conditions. This patient lives in a small city in the interior of the state of Paraíba, about 500km from the capital, and has difficulty in transport for clinical follow-up. She had disabling dyskinesia
for more than 50% of the day. The treatment indicated was the ablative technique (palidotomy) because it is the one that suits the patient's profile, as it is safe, low cost, effective and does not require adjustments such as neuromodulation. After surgery, dyskinesia totally regressed (UPDRS-part III pre: 65; 3 years later: 27) .Final comments: The therapeutic management of PD is based on a holistic view of the patient, which involves, in addition to their clinic, their socioeconomic conditions. Pallidotomy is a surgical procedure that offers excellent results, being indicated for patients who have difficulty in maintaining clinical follow-up due to inaccessibility to large centers.

Palavras Chave

Neurocirurgia, Transtornos do movimento, Doença de Parkinson