RESUMO
Background: The Periaqueductal gray (PAG) and the periventricular gray (PVG) are the anatomical targets for deep brain stimulation (DBS) to treat severe, refractory neuropathic pain. Methods: Seven (four female and three male) patients were qualified for PAG/PVG DBS because of neuropathic facial pain. Frame-based unilateral implantations of DBS were conducted according to indirect planning of the PAG/PVG, contralateral to reported pain (3389, Activa SC 37603, Medtronic). The efficacy of PAG/PVG DBS on pain was measured with Numeric Pain Rating Scale (NRS) and Neuropathic Pain Symptom Inventory (NPSI) before surgery and 3, 12, and 24 months after surgery. Results: The mean age of the group at the implantation was 43.7 years (range: 28-62; SD: 12.13). The mean duration of pain varied from 2 to 12 years (mean: 7.3; SD: 4.11). Five patients suffered from left-sided facial pain and two suffered right-sided facial pain. The etiology of pain among four patients was connected to ischemic brain stroke and in one patient to cerebral hemorrhagic stroke. Patients did not suffer from any other chronic medical condition The beginnings of ailments among two patients were related to craniofacial injury. NRS decreased by 54% at the 3 months follow-up. The efficacy of the treatment measured with mean NRS decreased at one-year follow-up to 48% and to 45% at 24 months follow-up. The efficacy of the treatment measured with NPSI decreased from 0.27 to 0.17 at 2 years follow-up (mean reduction by 38%). The most significant improvement was recorded in the first section of NPSI (Q1: burning- reduced by 53%). The records of the last section (number five) of the NPSI (paresthesia/dysesthesia- Q11/Q12) have shown aggravation of those symptoms by 10% at the two-years follow-up. No surgery- or hardware-related complications were reported in the group. Transient adverse effects related to the stimulation were eliminated during the programming sessions. Conclusion: PAG/PVG DBS is an effective and safe method of treatment of medically refractory neuropathic facial pain. The effectiveness of the treatment tends to decrease at 2 years follow-up. The clinical symptoms which tend to respond the best is burning pain. Symptoms like paresthesia and dysesthesia might increase after DBS treatment, even without active stimulation.
RESUMO
AIM: To assess the correlation between quality of life (QoL), depressive symptoms and motor signs in patients with Parkinson disease after subthalamic deep brain stimulation (DBS STN). MATERIAL AND METHODS: 74 patients, average age 55.6 ± 7 and duration of disease 12.3 years ± 3.8, treated with l STN DBS for PD were included in the study. All patients were evaluated with (UPDRS III), (PDQ-39) (BDI) at baseline and at 6, 12, and 24-month follow up. All patients were also stratified into three groups depending on UPDRS III improvement ( < 30%, 30-60%, > 60%). RESULTS: Scores in all scales significantly decreased from baseline. The improvement in PDQ-39 was 43.3%, in BDI 25.3 %; UPDRS-III 55.5% at 6 months. At 24 months, motor results and QoL deteriorated by 15.6% and 19.6% respectively. BDI remained unchanged. Mean scores at baseline in PDQ-39 were group I 67.4 ± 29.7; II 64.8 ± 32.0; III 53.4 ± 22.0 and for BDI, group I 17.4 ± 12.04; II 14.0 ± 9.7; III- 15.1 ± 10.55. Scores decreased significantly with DBS at 6-month follow-up and mean change was: PDQ-39, group I 42.7%, II- 40.7%, III 51.6%; BDI group I 23%, II 28.1%, III 23.3 %. CONCLUSION: Reduction of depressive symptoms, motor signs and improvement of QoL in PD after DBS STN are closely related. Improvement of QoL depends significantly on motor symptoms.
