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Efectividad y seguridad de la palidotomía posteroventral en el tratamiento de la enfermedad de Parkinson avanzada
Efficacy and safety of posteroventral pallidotomy for the treatment of advanced parkinson's disease
José Luis Molinuevo, Francesc Valldeoriola*, Fritz A. Nobbe, Eduardo Tolosa
Servicios de Neurología Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer. Universitat de Barcelona.
Jordi Rumiàa, Enric Ferrera
a Neurocirugía. Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer. Universitat de Barcelona
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        "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#58; Analizar la efectividad y seguridad de la palidotom&#237;a unilateral guiada por microrregistroen el tratamiento de la enfermedad de Parkinson &#40;EP&#41; avanzada despu&#233;s de 3 mesesy al a&#241;o de la intervenci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#58; Se intervinieron 23 pacientes con EP avanzada &#40;edad media&#44; 58&#44;9 a&#241;os&#59;duraci&#243;n media de la enfermedad&#44; 14&#44;4 a&#241;os&#41;&#46; La evaluaci&#243;n cl&#237;nica&#44; a los 3 meses &#40;n &#61; 23&#41; yal a&#241;o &#40;n &#61; 16&#41; de la intervenci&#243;n&#44; se efectu&#243; por la ma&#241;ana 12 h despu&#233;s de la &#250;ltima dosisde medicaci&#243;n &#40;off&#41; y tras la administraci&#243;n de un 100-150&#37; de la dosis habitual &#40;on&#41;&#46; Encada una de las evaluaciones se administraron escalas para valoraci&#243;n de las actividades de lavida diaria&#44; evaluaci&#243;n motora y discinesias&#44; as&#237; como pruebas cronometradas de la actividadmotora&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#58; Las discinesias contralaterales al hemisferio intervenido se redujeron un 92&#37; a los3 meses y un 89&#37; al a&#241;o&#46; Los s&#237;ntomas motores de la enfermedad mejoraron un 36&#44;5&#37; a los 3meses y un 26&#44;7&#37; al a&#241;o de la intervenci&#243;n&#46; En el an&#225;lisis anual apareci&#243; una mejor&#237;a en eltemblor contralateral del 48&#37;&#44; en la rigidez del 36&#44;2&#37; y en la bradicinesia del 37&#44;4&#37; Todoslos cambios observados fueron estad&#237;sticamente significativos &#40;p &#60; 0&#44;01&#41;&#46; Los efectos adversosfueron leves o transitorios&#46; La dosis de medicaci&#243;n antiparkinsoniana no se modific&#243; durante eltiempo de seguimiento&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#58; La palidotom&#237;a unilateral guiada por microrregistro es un m&#233;todo seguro y eficazpara mejorar los s&#237;ntomas de la EP contralaterales&#44; siendo especialmente eficaz en el tratamientode las discinesias inducidas por L-dopa&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#58; To analyze the results&#44; efficacy and safety of unilateral microelectrode guided pallidotomyfor the treatment of advanced Parkinson&#39;s disease&#44; three months and one year after surgery&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#58; 23 patients with advanced Parkinson&#39;s disease &#40;mean age 58&#44;9 years andmean disease duration 14&#44;4 years&#41; were submitted to pallidotomy&#46; Neurological evaluation&#44; threemonths &#40;n &#61; 23&#41; and one year &#40;n &#61; 16&#41; after surgery&#44; was performed during the morning inovernight &#171;off&#187; condition and after receiving 100-150&#37; of their usual l-dopa dose&#46; Parkinsoniansymptoms were evaluated in each follow up visit through motor scales&#44; activities of dailyliving scales&#44; a dyskinesia rating scale and motor timed tests&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">&#58; Contralateral dyskinesias improved 92&#37; three months after surgery and 89&#37; at oneyear&#46; Parkinsonian motor scores were reduced by 36&#46;5&#37; after three months and by 26&#46;7&#37; oneyear after surgery&#46; In the one year follow up visit&#44; contralateral tremor improved 48&#37;&#44; rigidity36&#46;2&#37; and bradykinesia 37&#46;4&#37;&#46; All these changes were statistically significant &#40;p &#60; 0&#46;01&#41;&#46; Adverseeffects were minor or transient&#46; Antiparkinsonian medication dosage did not significantlychange during the study period&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#58; Microelectrode guided unilateral pallidotomy is an effective and safe procedure toimprove contralateral motor symptoms in Parkinson&#39;s disease&#44; being specially useful for the treatmentof l-dopa induced dyskinesias&#46;</p>"
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