1052 Arq Neuropsiquiat r 2002;60(4)
SISTEM ATIC REVIEW OF STEREOTACTIC POSTEROVENTRAL PALLIDOTOM Y IN THE TREATM ENT OF PARKINSON’S DISEASE (ABSTRACT)* . THESIS. SÃO PAULO, 2001.
M ARCELO KEN – ITI HISATUGO * *
Parkinson’s disease is a chronic and irreversible dis-order. It is t he m ost f requent neurologic disease in t he populat ion over 65 years old. It is m anifest ed by “ car-dinal signs” of bradykinesia, cogw heel rigidit y, rest ing t rem or and post ural ref lex im pairm ent . The m ost im -port ant pat hophisiologic alt erat ion in Parkinson’s dis-ease is t he lost of dopaminergic neurons from subst an-t ia nigra pars com pacan-t a. Levodopa is an-t he m osan-t effecan-t i-ve drug t o t reat Parkinson’s disease but it s chronic use may complicat e w it h dyskinesia and fluct uat ions. Ow -ing t o lim it at ions and com plicat ions in t he chronic use of Levodopa t he surgery is a t herapeut ic opt ion.
The bibliographic search w as perform ed in five elet ronic daelet abases w ielet h five key w ords in elet he search selet raelet -egy: “ st ereot axis or st ereot act ic and pallidot om y and parkinson’s disease” . It w as set up inclusion and exclu-sion crit eria t o select art icles t o be analysed consider-ing t he m et hodologic qualit y and scient if ic evidence.
There w ere 55 art icles considered as clinical t rials. Six art icles w ere classif ied as cont rolled t rials. But only one w as m ore approxim at e t o t he ideal m et hodology t o st udy t reat ment efficacy.
The art icles’ qualit y w as poor and inf orm at ions about m et hods som et im es w ere om it ed.
The t ot al num ber of pat ient s w as 1827. The age varied from 17 t o 82 and 59% of t he operat ed ones w ere m en.
There w as found a great variat ion of scales t o m ea-sure t he surgery efficacy, but t he m ost used w as t he UPDRS ( Unified Parkinson’s Disease Rat ing Scale ).
Contralateral dyskinesias w as the symptom that sho-w ed t he best anssho-w er t o surgery.
Postural instability did not improve w ith pallidotomy. Am ong t he sixt een art icles t hat st udied neuropsy-chological effect s of post erovent ral pallidot om y only t hree det ect ed alt erat ions st at ist ically signif icant .
The complicat ions rat e didn’t seem t o be correlat ed t o t he t he use of m icroelet rode. The m ost f requent permanent complicat ions w ere visual scot omas, dysar-t hria and hem iparesis.
The m ain m ort alit y cause w as int racerebral hem or-rhage during surgery.
Cont rolled, random ized and double-blind clinical t rials w ill help t o answ er object ively and unbiased some unansw ered quest ions.
KEY WORDS: Parkinson disease, post ero-vent ral st e-reot act ic pallidot omy
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* Revisão sist emát ica sobre o t rat ament o da doença de Parkinson com a palidot omia póst ero-vent ral est ereot áxica (Resumo). Tese de M est rado, Universidade Federal de São Paulo (Área: Neurocirurgia). Orient ador: Fernando Pat riani Ferraz. Co-orient ador: Jair de Jesus M ari.
