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Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán

2021, Número 2

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Rev Biomed 2021; 32 (2)


Estimulación cerebral profunda para la enfermedad de Parkinson: criterios de selección, abordaje quirúrgico, efectos secundarios y controversias

Leal-Ortega R

Idioma: Español
Referencias bibliográficas: 49
Paginas: 113-123
Archivo PDF: 535.82 Kb.


RESUMEN

La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa más frecuente. Afecta a 6 millones de personas en el mundo y esta cifra incrementará en los próximos años. El manejo consiste en la combinación de fármacos, fisioterapia y terapia avanzada que incluye dispositivos de uso parenteral (bombas de apomorfina y levodopa intestinal), cirugía ablativa y cirugía funcional. La estimulación cerebral profunda (ECP) consiste en la aplicación de estímulos eléctricos a través de electrodos implantados en núcleos profundos del cerebro que van conectados a un generador de impulsos (“marcapaso cerebral”); es una técnica aprobada mundialmente con más de 150,000 pacientes intervenidos. La cirugía puede controlar los síntomas motores y algunos no motores que han fallado al control por el tratamiento médico. En general, un candidato a ECP es aquel que tiene EP durante al menos 5 años, buena respuesta a la levodopa, complicaciones motoras por el tratamiento y perfil cognitivo-psiquiátrico adecuado. Durante el procedimiento el neurocirujano dirige por medio de estereotaxia los electrodos al núcleo seleccionado mientras el neurólogo monitorea la fisiología celular para que queden implantados en el sitio exacto. Existen complicaciones significativas, pero prevenibles y tratables; durante el procedimiento y en el postoperatorio. En el año 2016 nuestro equipo realizó con éxito la primera cirugía de ECP en Mérida, Yucatán. El objetivo de este trabajo es realizar una revisión descriptiva del proceso de selección, el procedimiento quirúrgico, los efectos secundarios y las controversias de esta técnica.


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