RESUMO
OBJECTIVES: This study aims to describe resting state networks (RSN) in patients with disorders of consciousness (DOC)s after acute severe traumatic brain injury (TBI). METHODS: Adult patients with TBI with a GCS score <8 who remained in a coma, minimally conscious state (MCS), or unresponsive wakefulness syndrome (UWS), between 2017 and 2020 were included. Blood-oxygen-level dependent imaging was performed to compare their RSN with 10 healthy volunteers. RESULTS: Of a total of 293 patients evaluated, only 13 patients were included according to inclusion criteria: 7 in coma (54%), 2 in MCS (15%), and 4 (31%) had an UWS. RSN analysis showed that the default mode network (DMN) was present and symmetric in 6 patients (46%), absent in 1 (8%), and asymmetric in 6 (46%). The executive control network (ECN) was present in all patients but was asymmetric in 3 (23%). The right ECN was absent in 2 patients (15%) and the left ECN in 1 (7%). The medial visual network was present in 11 (85%) patients. Finally, the cerebellar network was symmetric in 8 patients (62%), asymmetric in 1 (8%), and absent in 4 (30%). CONCLUSIONS: A substantial impairment in activation of RSN is demonstrated in patients with DOC after severe TBI in comparison with healthy subjects. Three patterns of activation were found: normal/complete activation, 2) asymmetric activation or partially absent, and 3) absent activation.
Assuntos
Lesões Encefálicas Traumáticas , Transtornos da Consciência , Humanos , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/etiologia , Transtornos da Consciência/diagnóstico por imagem , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiopatologia , Imageamento por Ressonância Magnética , Idoso , Adulto Jovem , Descanso/fisiologia , Estado Vegetativo Persistente/fisiopatologia , Estado Vegetativo Persistente/diagnóstico por imagem , Estado Vegetativo Persistente/etiologiaRESUMO
Background: Parkinson's disease is poorly studied in Colombia. It is pharmacologically managed, but for refractory cases, surgery is a therapeutic option, positively impacting on quality of life. Objective: To determine the impact of deep brain stimulation as management in the control of progression in patients with Parkinson's disease attended our institution between the years 2014 to 2020. Method: Descriptive retrospective study, with patients collected between 2014 and 2020 undergoing deep brain stimulation surgery. The MDS-UPDRS (Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale) was applied in the pre- and postoperative period, and the results were compared. Results: 21 patients were included and the UPDRS was applied, finding a decrease in scores in the postoperative period. One patient had an operative site infection. Conclusions: There was an improvement in the MDS-UPDRS score, with a low rate of complications. The procedure time was prolonged from the preoperative evaluation. Deep brain stimulation is the management of choice for refractory Parkinson's disease. The patients in this series showed improvement in their symptoms. Unfortunately, there are limitations to perform this procedure in Colombia, such as the delay in the authorization of the procedure.
Antecedentes: La enfermedad de Parkinson está poco estudiada en Colombia. Es de manejo farmacológico, pero para casos refractarios la cirugía es una opción terapéutica que impacta positivamente en la calidad de vida. Objetivo: Determinar el impacto de la estimulación cerebral profunda como manejo en el control de la progresión en pacientes con enfermedad de Parkinson atendidos nuestra institución entre los años 2014 a 2020. Método: Estudio descriptivo de corte retrospectivo con pacientes recolectados entre los años 2014 y 2020 sometidos a cirugía de estimulación cerebral profunda. Se aplicó la MDS-UPDRS (Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale) en el pre- y el posoperatorio, y se compararon los resultados. Resultados: Se incluyeron 21 pacientes y se les aplicó la MDS-UPDRS, encontrando una disminución en las puntuaciones en el posoperatorio. Un paciente presentó infección del sitio operatorio. Conclusiones: Hubo mejoría en la puntuación de la MDS-UPDRS, con baja tasa de complicaciones. El tiempo de realización del procedimiento fue prolongado desde la valoración preoperatoria. La estimulación cerebral profunda es el manejo de elección para la enfermedad de Parkinson refractaria. Los pacientes de esta serie mostraron mejoría en sus síntomas. Desafortunadamente, existen limitaciones para la realización de este procedimiento en Colombia, como el retraso en la autorización del procedimiento.