RICARDO GALHARDONI
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conferenceObject Subthalamic deep brain stimulation modulates small fiber-dependent sensory threshold in Parkinson's disease(2015) CURY, R. G.; GALHARDONI, R.; FONOFF, E. T.; GHILARDI, M. G. dos Santos; MYCZKOWSKI, M.; MARCOLIN, M. A.; BARBOSA, E. R.; TEIXEIRA, M. J.; ANDRADE, D. Ciampi de- Effects of cerebellar transcranial magnetic stimulation on ataxias: A randomized trial(2020) FRANCA, Carina; ANDRADE, Daniel C. de; SILVA, Valquiria; GALHARDONI, Ricardo; BARBOSA, Egberto R.; TEIXEIRA, Manoel J.; CURY, Rubens G.Introduction: Cerebellar ataxia remains a neurological symptom orphan of treatment interventions, despite being prevalent and incapacitating. We aimed to study, in a double-blind design, whether cerebellar modulation could improve ataxia. Methods: We included patients with diagnosis of spinocerebellar ataxia type 3, multiple systems atrophy cerebellar type, or post-lesion ataxia. Patients received five sessions each of sham and active cerebellar 1 Hz deep repetitive transcranial magnetic stimulation in randomized order. Our primary outcome was the decrease in the Scale for the Assessment and Rating of Ataxia when comparing phases (active x sham). Secondary outcomes measures included the International Cooperative Ataxia Rating Scale, and other motor, cognitive, and quality of life scales. This study was registered at clinicaltrials.gov (protocol NCT03213106). Results: Twenty-four patients aged 29-74 years were included in our trial. After active stimulation, the Scale for the Assessment and Rating of Ataxia score was significantly lower than the score after sham stimulation [median (interquartile range) of 10.2 (6.2, 16.2) versus 12.8 (9.6, 17.8); p = 0.002]. The International Cooperative Ataxia Rating Scale score also improved after active stimulation versus sham [median (interquartile range) of 29.0 (21.0, 43.5) versus 32.8 (22.0, 47.0); p = 0.005]. Other secondary outcomes were not significantly modified by stimulation. No patient presented severe side effects, and nine presented mild and self-limited symptoms. Conclusions: Our protocol was safe and well-tolerated. These findings suggest that cerebellar modulation may improve ataxic symptom and provide reassurance about safety for clinical practice.
conferenceObject Subthalamic Deep Brain Stimulation Modulates Small-Fiber Dependent Sensory Thresholds in Parkinson's Disease(2012) ANDRADE, Daniel Ciampi De; LEFAUCHEUR, Jean-Pascal; GALHARDONI, Ricardo; FERREIRA, Karine; PAIVA, Anderson de; BOHR-SENG-SHU, Edson; ALVARENGA, Luciana; MYCZKOWSKI, Martin; MARCOLIN, Marco; SIQUEIRA, Silvia de; FONOFF, Erich; BARBOSA, Egberto; TEIXEIRA, ManoelconferenceObject Correlation between pain, other non-motor symptoms, quality of life and motor improvement in patients with Parkinson's disease after deep brain stimulation(2014) CURY, R. G.; GHILARDI, M. G.; GALHARDONI, R.; SOUZA, C.; FONOFF, F.; MARCOLIN, M. A.; MYCZKOWSKI, M. L.; TEIXEIRA, M. J.; BARBOSA, E. R.; FONOFF, E. T.; ANDRADE, D. Ciampi de- Effects of cerebellar neuromodulation in movement disorders: A systematic review(2018) FRANCA, Carina; ANDRADE, Daniel Ciampi de; TEIXEIRA, Manoel Jacobsen; GALHARDONI, Ricardo; SILVA, Valquiria; BARBOSA, Egberto Reis; CURY, Rubens GisbertBackground: The cerebellum is involved in the pathophysiology of many movement disorders and its importance in the field of neuromodulation is growing. Objectives: To review the current evidence for cerebellar modulation in movement disorders and its safety profile. Methods: Eligible studies were identified after a systematic literature review of the effects of cerebellar modulation in cerebellar ataxia, Parkinson's disease (PD), essential tremor (ET), dystonia and progressive supranuclear palsy (PSP). Neuromodulation techniques included transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS). The changes in motor scores and the incidence of adverse events after the stimulation were reviewed. Results: Thirty-four studies were included in the systematic review, comprising 431 patients. The evaluation after stimulation ranged from immediately after to 12 months after. Neuromodulation techniques improved cerebellar ataxia due to vascular or degenerative etiologies (TMS, tDCS and DBS), dyskinesias in PD patients (TMS), gross upper limb movement in PD patients (tDCS), tremor in ET (TMS and tDCS), cervical dystonia (TMS and tDCS) and dysarthria in PSP patients (TMS). All the neuromodulation techniques were safe, since only three studies reported the existence of side effects (slight headache after TMS, local skin erythema after tDCS and infectious complication after DBS). Eleven studies did not mention if adverse events occurred. Conclusions: Cerebellar modulation can improve specific symptoms in some movement disorders and is a safe and well-tolerated procedure. Further studies are needed to lay the groundwork for new researches in this promising target.
conferenceObject Pain in patients with Parkinson's disease after STN DBS: A prospective study(2013) CURY, R. G.; GUILARDI, M. G.; SOUZA, C. P.; PAIVA, A. R.; GALHARDONI, R.; FONOFF, F.; MARCOLIN, M. A.; MYCZKOWSKI, M. L.; ARNAUT, D.; FONOFF, E. T.; BARBOSA, E. R.; TEIXEIRA, M. J.; ANDRADE, D. C.- Subthalamic deep brain stimulation modulates conscious perception of sensory function in Parkinson's disease(2016) CURY, Rubens G.; GALHARDONI, Ricardo; TEIXEIRA, Manoel J.; GHILARDI, Maria G. dos Santos; SILVA, Valquiria; MYCZKOWSKI, Martin L.; MARCOLIN, Marco A.; BARBOSA, Egberto R.; FONOFF, Erich T.; ANDRADE, Daniel Ciampi deSubthalamic deep brain stimulation (STN-DBS) is used to treat refractory motor complications in Parkinson disease (PD), but its effects on nonmotor symptoms remain uncertain. Up to 80% of patients with PD may have pain relief after STN-DBS, but it is unknown whether its analgesic properties are related to potential effects on sensory thresholds or secondary to motor improvement. We have previously reported significant and long-lasting pain relief after DBS, which did not correlate with motor symptomatic control. Here we present secondary data exploring the effects of DBS on sensory thresholds in a controlled way and have explored the relationship between these changes and clinical pain and motor improvement after surgery. Thirty-seven patients were prospectively evaluated before STN-DBS and 12 months after the procedure compared with healthy controls. Compared with baseline, patients with PD showed lower thermal and mechanical detection and higher cold pain thresholds after surgery. There were no changes in heat and mechanical pain thresholds. Compared with baseline values in healthy controls, patients with PD had higher thermal and mechanical detection thresholds, which decreased after surgery toward normalization. These sensory changes had no correlation with motor or clinical pain improvement after surgery. These data confirm the existence of sensory abnormalities in PD and suggest that STN-DBS mainly influenced the detection thresholds rather than painful sensations. However, these changes may depend on the specific effects of DBS on somatosensory loops with no correlation to motor or clinical pain improvement.
conferenceObject Effects of Cerebellar Neuromodulation in Movement Disorders: A Systematic Review(2018) FRANCA, Carina; ANDRADE, Daniel De; TEIXEIRA, Manoel; GALHARDONI, Ricardo; SILVA, Valquiria; BARBOSA, Egberto; CURY, Rubens- Dentate nucleus stimulation in a patient with cerebellar ataxia and tremor after cerebellar stroke: A long-term follow-up(2019) CURY, Rubens Gisbert; FRANCA, Carina; BARBOSA, Egberto Reis; GALHARDONI, Ricardo; LEPSKI, Guilherme; TEIXEIRA, Manoel J.; ANDRADE, Daniel Ciampi de
- Safety and Outcomes of Dentate Nucleus Deep Brain Stimulation for Cerebellar Ataxia(2022) CURY, Rubens Gisbert; FRANCA, Carina; DUARTE, Kleber Paiva; PARAGUAY, Isabela; DINIZ, Juliete Melo; CUNHA, Paulina; GALHARDONI, Ricardo; SILVA, Valquiria; IGLESIO, Ricardo; BISSOLI, Andre Bortolon; LEPSKI, Guilherme; BARBOSA, Egberto Reis; TEIXEIRA, Manoel Jacobsen; ANDRADE, Daniel Ciampi deCerebellar symptoms remain orphan of treatment options despite being prevalent and incapacitating. Investigate whether dentate nucleus deep brain stimulation (DN DBS) is safe and leads to improvements in cerebellar symptoms when compared to sham stimulation. This randomized double-blind crossover pilot trial enrolled five patients with spinocerebellar ataxia type 3 or post-lesion ataxia. Active or sham phases were randomly performed three months apart. The primary outcome was ataxia improvement as measured by the Scale for the Assessment and Rating of Ataxia (SARA) after the active compared to the sham period. Secondary outcome measures included safety and tolerability, the Fahn-Tolosa-Marin Tremor Rating Scale (FTMRS), quality of life measurements, and patients' global impression of change. The effects on ataxia were numerically better in four out of five patients after active versus sham stimulation. The composite SARA score did not change after comparing active to sham stimulation (8.6 +/- 3.6 versus 10.1 +/- 4.1; p = 0.223). The FTMRS showed significant improvement after active stimulation versus sham (18.0 +/- 17.2 versus 22.2 +/- 19.5; p = 0.039) as did patients' global impression of change (p = 0.038). The quality of life was not modified by stimulation (p = 0.337). DN DBS was well tolerated without serious adverse events. One patient had the electrode repositioned. DN DBS is a safe and well tolerated procedure that is effective in alleviating cerebellar tremor. In this small cohort of ataxic patients, DN DBS did not achieve statistical significance for ataxia improvement.
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