Arq Neuropsiquiat r 2002;60(4) 1049
cessit y of special soft w are t o calculat e t he cart esian coordinat es. Are described it s developm ent and t ech-nic of use, and report ed t he aut hor’s experience w it h it s use, specially in t he t reat m ent of m ovem ent disor-ders and t o m ake int racranial biopsies, perform ed at Inst it ut o de Neurologia Deolindo Cout o, Universidade Federal do Rio de Janeiro, since 1997.
The aut hor developed a simple and pract ical appa-rat us, achieving a syst em t hat perm it s t he direct m ea-surement of X, Y and Z cartesian coordinates on the pro-per m onit or of com put ed t om ography. The st ereot ac-t ic apparaac-t us is com posed by a head ring, ac-t haac-t is fixed to skull w ith three or four stainless steel screw s, a rulers system that permits movements of the arc to front or back, to up or dow n, to inside or outside, and moreover t w o t ypes of f ree angulat ion: of t he cilinder and of t he needle in t he arc. The pat ient perf orm s t he brain com -put ed t om ographic scan w it h t he head ring fixed w it h t he screw s, w hich ext rem it ies t ouch t he ext ernal bone skull board and do not permit any movement. At the side of the ring, are placed localizing plaques, in the right
and left , t hat permit t he direct correlat ion bet w een t he t om ographic scan t arget t o t he t ridim ensional coordi-nates, related to the ring. So, the zero point (X0, Y0, Z0) is t he cent er of t he ring circumference, at it s superior surface. The movement s are performed w it h t he linear sliding, m ilim et red in t he t hree cart esian axis (X, Y, Z), and there is no neccessity to the calculation of any angle. With the coordinates calculated and in the operation room, the apparatus is set, fixed to the ring. The rulers movements are performed in the three axis, perm it ing t hat t he needle point t ouch t he t arget point pre-f ixed. The f ree angulat ions perm it m ovem ent s t o choice t he best w ay t o t ouch t he t arget . The developed appa-rat us present s precison com parable t o t he t arget cen-t ered arcs apparacen-t us in use now adays (2 mm). Icen-t pre-sent s t echnology ent irely nat ional, easy handling, and it s development has been diffusing in t echnical-cient ific enviroinment , specially t hrough t he report s of aut hor’s experience w it h it s use.
KEY WORDS: st ereot act ic neurosurgery, int racranial biopsy, f unct ional neurosurgery.
* Desenvolviment o de aparelho arco alvo-cent rado para procediment os est ereot áct icos neurocirúrgicos (Resumo). Tese de Dout orado, Universidade Federal do Rio de Janeiro, (Área: Engenharia de Produção). Orient adores: Carlos Albert o Nunes Cosenza e Ricardo Wagner.
* * Address: Rua Djalma Ulrich 201 / 1201, 22071-020 Rio de Janeiro RJ, Brasil. E-mail [email protected]
DEPRESSION IN PARKINSON’S DISEASE: STUDY OF 60 CASES (ABSTRACT)* . THESIS. SÃO PAULO 2001.
ROBERTO CÉSAR PEREIRA DO PRADO* *
Neuropsychiat ric disorders, specially depression, are f requent in Parkinson’s disease (PD), how ever t hese sym p t om s are of t en und errecognized b y neurolo-gist s.The object ives of t his st udy w ere: 1) t o emphasize the need of a better approach to neuropsychiatric symp-t om s in PD by symp-t he neurologissymp-t s, in order symp-t o ensure an early diagnosis and proper t reat m ent of depression. 2) t o evaluat e t he clinical charact erist ics and t he frequency of depression in PD. 3) t o st udy t he correlat ions of de-pression in PD w it h ot her variables, discussing t he neu-rophysiological m echanism s of depression in PD.
Sixty patients w ho fulfilled the clinical criteria for PD (primary), 56.6% male, non dement ed, ages ranging from 44 to 85 years old, in different stages of the disease (Hoehn & Yahr modified), w ere submitted to the UPDRS-III, V and VI, Clinical Interview Schedule – revised edit ion (CIS-R), a sem i-st ruct ured int erview in order t o det ect neuropsychiat ric sym pt om s and t he Ham ilt on
depres-sion scale (HAM -D), applied by t he exam iner/aut hor. The most prevalent psychiat ric sympt oms w ere sleep disorder (40%), depression + depressive ideas (38.33%), w orry (30%), anxiet y (25%), obsessions (23.33%), con-centration (18.33%), irritability (11.66%), panic (8.33%), com pulsions (5%), phobias (5%). There w as not sig-nificant correlat ion bet w een depression and: sex, age of onset , current age and cognit ive funct ion. A signifi-cant correlat ion w as found bet w een depression and UPDRS-III, V and VI. A significant correlat ion w as also found bet w een depression, anxiet y and irrit abilit y.
The frequency of depression in PD in t his st udy w as arround 40% and had it s ow n charact erist ics. The ut ili-zat ion of st ruct ured int erview s and evaluat ion scales is essent ial for an accurat e diagnosis and proper t reat -m ent of depression in PD.
KEY W ORDS: Parkinson’s disease, depression.
* Depressão na doença de Parkinson: est udo de 60 casos (Resumo). Tese de Dout orado, Universidade de São Paulo (Área: Neurologia). Orient ador: Egbert o Reis Barbosa.
