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Bacterial keratitis in a tertiary hospital in São Paulo: a 21-year review of the epidemiological, laboratory, and clinical data
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Zaccaron, Beatriz Avila

; Araújo, Maria Emilia Xavier dos Santos

; Paula, Alexandre Inácio Cruz de

; Costa, Bruno de Mendonça

; Papalini, Emellyne Pamela Diniz Pires

; Pinto, Roberta Arb Saba Rodrigues

Brazilian Journal of Infectious Diseases

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2023, Volume 27 N. 5 elocation 102809

Abstract: En | Text: En | PDF: En

ABSTRACT Infectious keratitis is a sight-threatening condition that is usually an ocular emergency. The visual outcome depends on prompt and accurate clinical management as well as geographic and epidemiological awareness. We conducted a retrospective observational study to define the epidemiological and laboratory profile, as well as the clinical course of bacterial keratitis in a tertiary hospital in São Paulo over 21 years. Information about age, sex, predisposing factors, topical and surgical treatment, visual acuity, ulcers’ classification, bacterioscopy, culture, and antibiotic sensitivity tests were collected. This study included 160 patients. The mean age was 65.1 ± 18.4 years and risk factors were identified in 83.1 % of the patients. Empirical topical fortified cephalosporin with an aminoglycoside or fourth-generation fluoroquinolone was curative for 66.2 % of the cases. The mean treatment duration was 22.5 ± 9 days. The mean variation of visual acuity was −0.25 logMAR, p < 0.001. Culture revealed 64 % of Gram-positive bacteria. All Gram-positive bacteria were sensitive to cephalothin, vancomycin, and quinolones. All Gram-negative bacteria were sensitive to gentamicin, tobramycin, amikacin, and ciprofloxacin. These findings reinforce the importance of prompt empirical treatment of severe corneal ulcers with a fortified cephalosporin and aminoglycoside or a fourth-generation fluoroquinolone as there are equally effective. Collected data was insufficient to evaluate resistance of ocular infections over time in this population.

https://doi.org/10.1016/j.bjid.2023.102809

Guidelines for Parkinson’s disease treatment: consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology - motor symptoms
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Saba, Roberta Arb

; Maia, Débora Palma

; Cardoso, Francisco Eduardo Costa

; Borges, Vanderci

; F. Andrade, Luiz Augusto

; Ferraz, Henrique Ballalai

; Barbosa, Egberto Reis

; Rieder, Carlos Roberto de Mello

; da Silva, Delson José

; Chien, Hsin Fen

; Capato, Tamine

; Rosso, Ana Lúcia

; Souza Lima, Carlos Frederico

; Bezerra, José Marcelo Ferreia

; Nicaretta, Denise

; Povoas Barsottini, Orlando Graziani

; Godeiro-Júnior, Clécio

; Broseghini Barcelos, Lorena

; Cury, Rubens Gisbert

; Spitz, Mariana

; Azevedo Silva, Sônia Maria César

; Della Colletta, Marcus Vinicius

Arquivos de Neuro-Psiquiatria

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mar 2022, Volume 80 N. 3 Pages 316 - 329

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O tratamento da doença de Parkinson (DP) constitui um desafio, especialmente por ser considerado muito individualizado. A Academia Brasileira de Neurologia (ABN) identificou a necessidade de disseminar o conhecimento sobre o manejo do tratamento da DP, adaptando as melhores evidências à realidade brasileira. Assim, foi realizada uma revisão sobre as principais orientações de tratamento publicadas, baseada nas recomendações elaboradas por um grupo de especialistas em transtornos do movimento do departamento científico da ABN.

ABSTRACT The treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.

https://doi.org/10.1590/0004-282x-anp-2021-0219

Use of non-invasive stimulation in movement disorders: a critical review
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Godeiro, Clecio

; França, Carina

; Carra, Rafael Bernhart

; Saba, Felipe

; Saba, Roberta

; Maia, Débora

; Brandão, Pedro

; Allam, Nasser

; Rieder, Carlos R. M.

; Freitas, Fernando Cini

; Capato, Tamine

; Spitz, Mariana

; Faria, Danilo Donizete de

; Cordellini, Marcela

; Veiga, Beatriz A. A. G.

; Rocha, Maria Sheila G.

; Maciel, Ricardo

; Melo, Lucio B. De

; Möller, Patricia D. S.

; R. R. Júnior, Magno

; Fornari, Luís H. T.

; Mantese, Carlos E.

; Barbosa, Egberto Reis

; Munhoz, Renato P.

; Coletta, Marcus Vinicius Della

; Cury, Rubens Gisbert

Arquivos de Neuro-Psiquiatria

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jul 2021, Volume 79 N. 7 Pages 630 - 646

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: A estimulação não-invasiva tem sido amplamente utilizada nos últimos 30 anos no estudo e no tratamento de um grande número de doenças neurológicas, incluindo distúrbios do movimento. Objetivos: Nesta revisão crítica, discutimos o embasamento científico do uso da estimulação não-invasiva em distúrbios do movimento e as evidências científicas dos principais ensaios clínicos realizados. Métodos: Um grupo de especialistas realizou uma revisão crítica abrangente da literatura a fim de analisar as principais aplicações da estimulação magnética transcraniana (EMT) e da estimulação transcraniana por corrente contínua (ETCC) em distúrbios do movimento. As classes de evidência e de recomendação foram descritas para cada doença. Resultados: Apesar da grande variabilidade da metodologia e baixo efeito clínico, a EMT é provavelmente eficaz para o tratamento dos sintomas motores e da depressão na doença de Parkinson. A eficácia em outros distúrbios do movimento ainda é incerta. A EMT é possivelmente eficaz para o tratamento da distonia focal da mão, do tremor essencial e da ataxia cerebelar. No entanto, é provavelmente ineficaz na redução dos tiques na síndrome de Tourette. Finalmente, a ETCC é provavelmente eficaz na melhora da marcha na doença de Parkinson. Conclusões: As evidências até o momento sugerem que a estimulação não-invasiva pode ser benéfica para o alívio de alguns sintomas em determinados distúrbios do movimento como a doença de Parkinson, o tremor essencial, a distonia e a ataxia. Os protocolos de aplicação e paradigmas de estimulação ainda precisam ser investigados em ensaios clínicos maiores, assim como os seus efeitos a longo prazo.

Abstract Background: Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders. Objective: In this critical review, we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date. Methods: A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease. Results: Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson’s disease (PD). The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD. Conclusions: There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.

https://doi.org/10.1590/0004-282x-anp-2020-0381 427 downloads

Cannabinoids in Neurology - Position paper from Scientific Departments from Brazilian Academy of Neurology
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BRUCKI, Sonia Maria Dozzi

; ADONI, Tarso

; ALMEIDA, Carlos Mauricio Oliveira

; ANDRADE, Daniel Ciampi de

; ANGHINAH, Renato

; BARBOSA, Luciana Mendonça

; BAZAN, Rodrigo

; CARVALHO, Alzira Alves de Siqueira

; CARVALHO, William

; CHRISTO, Paulo Pereira

; COLETTA, Marcus Della

; CONFORTO, Adriana Bastos

; CORREA-NETO, Ylmar

; ENGELHARDT, Eliasz

; FRANÇA JUNIOR, Marcondes Cavalcante

; FRANCO, Clelia

; VON GLEHN, Felipe

; GOMES, Helio Rodrigues

; HOULY, Caroline Gomes de Barros

; KAUP, Alexandre Ottoni

; KOWACS, Fernando

; KANASHIRO, Aline

; LOPES, Victor Gonçalves

; MAIA, Débora

; MANREZA, Maria

; MARTINEZ, Alberto Rolim Muro

; MARTINEZ, Sandra Cristina Gonçalves

; NADER, Saulo Nardy

; NEVES, Luciana de Oliveira

; OKAMOTO, Ivan Hideyo

; OLIVEIRA, Rogério Adas Ayres de

; PEIXOTO, Fabiano de Melo

; PEREIRA, Cristiana Borges

; SABA, Roberta Arb

; SAMPAIO, Leticia Pereira de Brito

; SCHILLING, Lucas Porcello

; SILVA, Marcus Tulius Teixeira

; SILVA, Emanuelle Roberta

; SMID, Jerusa

; SOARES, Cristiane Nascimento

; SOBREIRA-NETO, Manoel

; SOUSA, Nise Alessandra de Carvalho

; SOUZA, Leonardo Cruz de

; TEIVE, Hélio Afonso Ghizoni

; TERRA, Vera Cristina

; VALE, Matheus

; VIEIRA, Vitor Mendes Grise

; ZANOTELI, Edmar

; PRADO, Gilmar

Arquivos de Neuro-Psiquiatria

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apr 2021, Volume 79 N. 4 Pages 354 - 369

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Os canabinoides compreendem os endocanabinoides, fitocanabinoides e os canabinoides sintéticos e desempenham ações no sistema nervoso central e periférico. Uma quantidade enorme de publicações tem sido lançada nos últimos anos, embora a cannabis seja conhecida por milênios. Os Departamentos Científicos da Academia Brasileira de Neurologia descreveram as evidências do uso médico em suas áreas. A literatura está em constantes mudanças e possíveis novas evidências podem surgir nos próximos dias ou meses. A prescrição dessas substâncias deve ser discutida com os pacientes e suas famílias, com conhecimento sobre eventos adversos e sua eficácia.

ABSTRACT Cannabinoids comprehend endocannabinoids, phytocannabinoids, and synthetic cannabinoids, with actions both in the central and peripherical nervous systems. A considerable amount of publications have been made in recent years, although cannabis has been known for over a thousand years. Scientific Departments from the Brazilian Academy of Neurology described evidence for medical use in their areas. Literature is constantly changing, and possible new evidence can emerge in the next days or months. Prescription of these substances must be discussed with patients and their families, with knowledge about adverse events and their efficacy.

https://doi.org/10.1590/0004-282x-anp-2020-0432 1049 downloads

Free carnitine and branched chain amino acids are not good biomarkers in Huntington’s disease
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CASTILHOS, Raphael Machado

; AUGUSTIN, Marina Coutinho

; SANTOS, José Augusto dos

; PEDROSO, José Luiz

; BARSOTTINI, Orlando

; SABA, Roberta

; FERRAZ, Henrique Ballalai

; VARGAS, Fernando Regla

; FURTADO, Gabriel Vasata

; Polese-BONATTO, Marcia

; RODRIGUES, Luiza Paulsen

; SENA, Lucas Schenatto

; VARGAS, Carmen Regla

; SARAIVA-PEREIRA, Maria Luiza

; JARDIM, Laura Bannach

; NEUROGENÉTICA, Rede

Arquivos de Neuro-Psiquiatria

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feb 2020, Volume 78 N. 2 Pages 81 - 87

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: A doença de Huntington (DH), causada por uma repetição CAG expandida no HTT, não possui tratamento e biomarcadores são necessários para futuros ensaios clínicos. Objetivo: Nosso objetivo foi verificar se os níveis de carnitina livre e aminoácidos de cadeia ramificada se comportam como potenciais biomarcadores na DH. Métodos: Portadores sintomáticos e assintomáticos e controles foram recrutados. Idade, sexo, índice de massa corporal (IMC), idade de início, duração da doença, escores UHDRS e trato CAG expandido foram obtidos; valina, leucina, isoleucina e carnitina livre foram medidas. Foram realizadas análises basal e longitudinal. Resultados: Setenta e quatro portadores sintomáticos, 20 portadores assintomáticos e 22 não portadores foram incluídos. No início do estudo, os níveis de valina estavam reduzidos em portadores de DH sintomáticos e assintomáticos quando comparados aos não portadores. Não foram observadas diferenças nos níveis de carnitina livre ou isoleucina + leucina entre os grupos. O IMC dos indivíduos sintomáticos foi menor que o dos não portadores. Níveis de valina correlacionaram-se com o IMC. Avaliação de acompanhamento foi realizada em 43 indivíduos sintomáticos. A pontuação do escore motor total da UHDRS aumentou 4,8 pontos/ano em média. Não foram observadas reduções significativas no IMC ou na valina, enquanto os níveis de carnitina livre e isoleucina+leucina aumentaram. Conclusões: Embora os níveis de valina tenham sido menores nos portadores de DH e estivessem relacionados às perdas de IMC observadas em indivíduos pré-sintomáticos, nenhum desses metabólitos parece ser biomarcador para a DH.

ABSTRACT Background: Huntington’s disease (HD), caused by an expanded CAG repeat at HTT, has no treatment, and biomarkers are needed for future clinical trials. Objective: The objective of this study was to verify if free carnitine and branched chain amino acids levels behave as potential biomarkers in HD. Methods: Symptomatic and asymptomatic HD carriers and controls were recruited. Age, sex, body mass index (BMI), age of onset, disease duration, UHDRS scores, and expanded CAG tract were obtained; valine, leucine, isoleucine, and free carnitine were measured. Baseline and longitudinal analysis were performed. Results: Seventy-four symptomatic carriers, 20 asymptomatic carriers, and 22 non-carriers were included. At baseline, valine levels were reduced in symptomatic and asymptomatic HD carriers when compared to non-carriers. No difference in free carnitine or isoleucine+leucine levels were observed between groups. BMI of symptomatic individuals was lower than those of non-carriers. Valine levels correlated with BMI. Follow-up evaluation was performed in 43 symptomatic individuals. UHDRS total motor score increased 4.8 points/year on average. No significant reductions in BMI or valine were observed, whereas free carnitine and isoleucine+leucine levels increased. Conclusions: Although valine levels were lower in HD carriers and were related to BMI losses observed in pre-symptomatic individuals, none of these metabolites seem to be biomarkers for HD.

https://doi.org/10.1590/0004-282x20190152 937 downloads

Minimal prevalence of Huntington’s disease in the South of Brazil and instability of the expanded CAG tract during intergenerational transmissions
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Castilhos, Raphael Machado de

; Santos, José Augusto dos

; Augustin, Marina Coutinho

; Pedroso, José Luiz

; Barsottini, Orlando

; Saba, Roberta

; Ferraz, Henrique Ballalai

; Godeiro Junior, Clécio

; Vargas, Fernando Regla

; Salarini, Diego Zanotti

; Furtado, Gabriel Vasata

; Polese-Bonatto, Marcia

; Rodrigues, Luiza Paulsen

; Sena, Lucas Schenatto

; Saraiva-Pereira, Maria Luiza

; Jardim, Laura Bannach

Genetics and Molecular Biology

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jun 2019, Volume 42 N. 2 Pages 329 - 336

Abstract: En | Text: En | PDF: En

Abstract Huntington’s disease (HD) is due to dominant expansions of the CAG repeat of the HTT gene. Meiotic instability of the (CAG)n might impact the disorder frequency. We report on HD minimal prevalence in Rio Grande do Sul (RS) state, Brazil, and on intergenerational instability of the (CAG)n in HD families. Symptomatic and at-risk subjects from 179 HD families were ascertained between 2013 and 2016. Clinical, molecular and family history data were obtained. Expanded (CAG)n length differences between parent and child (delta-expanded-(CAG)n) were calculated. Effect of parental age on the (CAG)n instability upon transmission was inferred by correlating delta-expanded-(CAG)n between siblings to their age differences. HD minimal prevalence in RS state was estimated as 1.85:100,000 inhabitants. Alleles with (CAG)27-35 were found on 21/384 non-disease associated chromosomes (5.5%); among 253 expanded alleles, four (1.6%) were within reduced penetrance range with (CAG)36-39. In 32 direct transmissions, mean instability was larger among paternal than maternal transmissions. In direct transmissions and in 51 sibling pairs, parental age at the time of child birth were not correlated with delta-expanded-(CAG)n. Briefly, HD prevalence in RS state was lower than those reported for European populations. Expanded (CAG)n transmissions were unstable and not associated to parental age.

https://doi.org/10.1590/1678-4685-gmb-2018-0032 1288 downloads

Diffusion tensor imaging of brain white matter in Huntington gene mutation individuals
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Saba, Roberta Arb

; Yared, James H.

; Doring, Thomas M.

; Phys, Med

; Borges, Vanderci

; Ferraz, Henrique Ballalai

Arquivos de Neuro-Psiquiatria

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aug 2017, Volume 75 N. 8 Pages 503 - 508

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Avaliar o envolvimento da substância branca (SB) cerebral em indivíduos com mutação do gene da huntingtina. Métodos Foram avaliados 34 indivíduos: 11 com mutação do gene da huntingtina sintomática, 12 assintomáticos com mutação do gene da huntingtina e 11 indivíduos controles. Realizamos ressonância magnética cerebral para avaliar a integridade da SB usando o tensor de difusão (DTI), com medição da anisotrofia fracionada (FA). Resultados Observamos uma diminuição da FA no trato corticoespinhal, coroa radiada, corpo caloso (joelho, corpo e esplênio), cápsula externa, radiações talâmicas, fascículo longitudinal superior e inferior, e fascículo frontal-occipital inferior no grupo dos indivíduos com mutação sintomática. A redução da FA é indicativa de processo degenerativo e perda axonal. Não houve diferença estatística entre os grupos controle e pré-sintomático. Conclusão Houve comprometimento da integridade da SB em indivíduos com mutação no gene da Huntingtina sintomática, mas outros estudos são necessários para avaliar a sua utilidade na progressão do processo neurodegenerativo.

ABSTRACT Objective To evaluate the role of the involvement of white matter tracts in huntingtin gene mutation patients as a potential biomarker of the progression of the disease. Methods We evaluated 34 participants (11 symptomatic huntingtin gene mutation, 12 presymptomatic huntingtin gene mutation, and 11 controls). We performed brain magnetic resonance imaging to assess white matter integrity using diffusion tensor imaging, with measurement of fractional anisotropy. Results We observed a significant decrease of fractional anisotropy in the cortical spinal tracts, corona radiate, corpus callosum, external capsule, thalamic radiations, superior and inferior longitudinal fasciculus, and inferior frontal-occipital fasciculus in the Huntington disease group compared to the control and presymptomatic groups. Reduction of fractional anisotropy is indicative of a degenerative process and axonal loss. There was no statistically significant difference between the presymptomatic and control groups. Conclusion White matter integrity is affected in huntingtin gene mutation symptomatic individuals, but other studies with larger samples are required to assess its usefulness in the progression of the neurodegenerative process.

https://doi.org/10.1590/0004-282x20170085 2170 downloads

Avaliação das atividades da vida diária dos pacientes com doença de Parkinson submetidos a cirurgia estereotáxica
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Pinto, Roberta Arb Saba Rodrigues

; Borges, Vanderci

; Aguiar, Patrícia Maria C.

; Ferraz, Fernando A.P.

; Hisatugo, Marcelo Ken-Iti

; Ferraz, Henrique Ballalai

Arquivos de Neuro-Psiquiatria

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jun 2002, Volume 60 N. 2B Pages 435 - 441

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar o impacto da cirurgia estereotáxica sobre a realização das atividades da vida diária dos paciente com doença de Parkinson (DP). MÉTODO: Foram avaliados 30 pacientes com DP forma idiopática submetidos a cirurgia estereotáxica nos períodos pré-operatório, 1º, 3º, 6º e 12º mês pós-operatório, segundo as escala UPDRS - Item II (escala unificada para DP), Schwab & England e Hoehn & Yahr. Destes, nove pacientes foram também avaliados no 24º mês pós-operatório. RESULTADOS: Foram realizadas nove palidotomias póstero-ventrais (PPV), sendo duas à esquerda e sete à direita; duas PPV bilaterais no mesmo tempo cirúrgico; 17 talamotomias ventro-laterais (TVL), sendo 12 à esquerda e cinco à direita; duas TVL à esquerda com PPV à direita no mesmo tempo cirúrgico. Os escores médios, na fase off, das escalas utilizadas foram: 65,6 no pré-operatório,74 no 1º mês, 76,6 no 3º mês, 75,6 no 6º mês e 72,3 no 12º mês pós-operatório (Schwab & England); 21 no pré-operatório, 12,3 no 1º mês, 14,7 no 3º mês, 15,27 no 6º mês e 17,1 no 12º mês pós-operatório (UPDRS); 3,1 no pré-operatório, 2,8 no 1º mês, 2,7 no 3º mês, 2,8 no 6º mês e 2,85 no 12º mês pós-operatório (Hoehn & Yarh). CONCLUSÃO: A TVL e a PPV são procedimentos capazes de melhorar a independência dos pacientes para realização das atividades cotidianas, sendo constatado benefício maior nos seis primeiros meses de pós-operatório.

OBJECTIVE: To evaluate the impact of stereotactic surgery on daily activities of Parkinson's disease (PD) patients. METHOD: Thirty patients with idiopathic PD were evaluated before surgery and one, three, six and twelve months after surgery. Patients were evaluated with the UPDRS - part II (Unified Parkinson's Disease Rating Scale) and the Schwab & England scales. Nine of the patients had also been evaluated after twenty four months. RESULTS: We performed nine posteroventral pallidotomies (PVP), two on the left hemisphere and seven on the right; 17 ventrolateral thalamotomies (VLT), 12 on the left and five on the right; two VLT on the left associated with PVP on the right at the same surgical procedure. The mean "off" phase scores of Schwab & England scale were: 60.6 before surgery, 74 after the first, 76.6 after the third, 75.6 after the sixth, 72.3 after the twelfth and 71.1 after the twenty fourth months after surgery. The mean "off" phase scores of UPDRS - part II scale were: 21 before surgery, 12.3 after the first, 14.7 after the third, 15.27 after the sixth, 17.1 after the twelfth and 17.5 after the twenty fourth months after surgery. CONCLUSION: VTL and PVP are useful procedures to improve daily living activities of the PD patients and the best results are seen by six months after surgery.

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Motor performance after posteroventral pallidotomy and VIM-thalamotomy in Parkinson's disease: a 1-year follow-up study
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AGUIAR, PATRÍCIA M. C.

; FERRAZ, HENRIQUE B.

; FERRAZ, FERNANDO P.

; SABA, ROBERTA ARB

; HISATUGO, MARCELO KEN-ITI

; ANDRADE, LUIZ AUGUSTO FRANCO DE

Arquivos de Neuro-Psiquiatria

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sep 2000, Volume 58 N. 3B Pages 830 - 835

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Vinte e três pacientes portadores de doença de Parkinson foram submetidos a cirurgia estereotáxica para tratamento da doença. Com o objetivo de estudar o desempenho motor a longo prazo, os pacientes foram avaliados clinicamente no período pré-operatório, no 1°, 3°, 6°, e 12° mês pós-operatório, com as seguintes escalas: Escala Unificada para Doença de Parkinson (Unified Parkinson's Disease Rating Scale-UPDRS), item III, escore motor e com a Escala de Larsen para Discinesias. Os pacientes que utilizavam levodopa foram avaliados nos estados "off" e "on". Foram realizadas 14 talamotomias ventro-laterais (TVL) unilaterais, 4 palidotomias póstero-ventrais (PPV) unilaterais, 2 PPV bilaterais; 3 TVL associadas à PPV contralateral. O benefício motor foi observado de forma significante no estado "off", e manteve-se a longo prazo na maioria dos pacientes, exceto em 2. Houve melhora da qualidade do período "on", devido ao controle das discinesias. A melhora das discinesias se manteve a longo prazo na maioria dos pacientes. As cirurgias não promoveram um decréscimo significante na dose de levodopa.Três pacientes tiveram complicações permanentes, mas nenhuma delas foi considerada grave e nem houve prejuízo funcional importante em decorrência das mesmas.

Twenty-three patients with Parkinson's disease underwent stereotactic surgery. To study the long-term motor performance, the patients were evaluated at the pre-operative period and at the 1st, 3rd, 6th, and 12th post-operative months, with the following scales: Unified Parkinson's Disease Rating Scale (UPDRS) motor score and Larsen's Scale for Dyskinesias. The patients under levodopa therapy were assessed both in "on" and "off" periods. Fourteen unilateral ventrolateral thalamotomies (VLT), 4 unilateral posteroventral pallidotomies (PVP), 2 bilateral PVP, and 3 VLT with contralateral PVP were performed. The motor improvement was significant and long-lasting in the "off" period, except for 2 patients. The "on" period quality improved, mainly due to the control of dyskinesias. The improvement of dyskinesias was long-lasting for the majority of the patients. There was no significant decrease in the levodopa dose. Three patients showed permanent complications, but none was severe.

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