RUBENS GISBERT CURY
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Surgical treatment of dystonia(2018) CURY, Rubens Gisbert; KALIA, Suneil Kumar; SHAH, Binit Bipin; JIMENEZ-SHAHED, Joohi; PRASHANTH, Lingappa Kumar; MORO, ElenaIntroduction: Treatment of dystonia should be individualized and tailored to the specific needs of patients. Surgical treatment is an important option in medically refractory cases. Several issues regarding type of the surgical intervention, targets, and predict factors of benefit are still under debate.Areas covered: To date, several clinical trials have proven the benefit and safety of deep brain stimulation (DBS) for inherited and idiopathic isolated dystonia, whereas there is still insufficient evidence in combined and acquired dystonia. The globus pallidus internus (GPi) is the target with the best evidence, but data on the subthalamic nucleus seems also to be promising. Evidence suggests that younger patients with shorter disease duration experience greater benefit following DBS. Pallidotomy and thalamotomy are currently used in subset of carefully selected patients. The development of MRI-guided focused ultrasound might bring new options to ablation approach in dystonia.Expert commentary: GPi-DBS is effective and safe in isolated dystonia and should not be delayed when symptoms compromise quality of life and functionality. Identifying the best candidates to surgery on acquired and combined dystonias is still necessary. New insights about pathophysiology of dystonia and new technological advances will undoubtedly help to tailor surgery and optimize clinical effects.
- Cerebellum as a possible target for neuromodulation after stroke(2018) FRANCA, Carina; ANDRADE, Daniel Ciampi de; TEIXEIRA, Manoel Jacobsen; CURY, Rubens Gisbert
conferenceObject Targeting the Right Spot in a Patient with Essential Tremor and Parkinson's Disease: Does the Tractography Matter?(2018) LISTIK, Clarice; SANTIAGO, Natally; REIS, Paul; GODINHO, Fabio; DUARTE, Kleber Paiva; TEIXEIRA, Manoel; BARBOSA, Egberto; CURY, Rubens Gisbert- Effects of Subthalamic Stimulation on Olfactory Function in Parkinson Disease(2018) CURY, Rubens Gisbert; CARVALHO, Margarete de Jesus; LASTEROS, Fernando Jeyson Lopez; DIAS, Alice Estevo; GHILARDI, Maria Gabriela dos Santos; PAIVA, Anderson Rodrigues Brandao; COUTINHO, Artur Martins; BUCHPIGUEL, Carlos Alberto; TEIXEIRA, Manoel J.; BARBOSA, Egberto Reis; FONOFF, Erich TalamoniBACKGROUND: Olfactory dysfunction is a nonmotor symptom of Parkinson disease (PD) associated with reduction in quality of life. There is no evidence on whether improvements in olfaction after subthalamic deep brain stimulation (STN-DBS) may be directly attributable to motor improvement or whether this reflects a direct effect of DBS on olfactory brain areas. The aim of the present study was to evaluate the effect of DBS on olfactory function in PD, as well as to explore the correlation between these changes and changes in motor symptoms and brain metabolism. METHODS: Thirty-two patients with PD were screened for STN-DBS. Patients were evaluated before and 1 year after surgery. Primary outcome was the change in olfactory function (Sniffin' Sticks odor-identification test [SST]) after surgery among the patients with hyposmia at baseline. Secondary outcomes included the relationship between motor outcomes and olfactory changes and [F-18] fluo-rodeoxyglucose-positron emission tomography analysis between subgroups with improvement versus no improvement of smell. RESULTS: STN-DBS improved SST after surgery (preoperative SST, median 7.3 +/- 2.4 vs. postoperative SST, median 8.2 +/- 2.1; P = 0.045) in a subset of patients among 29 of 32 patients who presented with hyposmia at baseline. The improvement in SST was correlated with DBS response (r = 0.424; P = 0.035). There was also an increase in glucose metabolism in the midbrain, cerebellum, and right frontal lobe in patients with SST improvement (P < 0.001). CONCLUSIONS: STN-DBS improves odor identification in a subset of patients with PD. Motor improvement together with changes in the brain metabolism may be linked to this improvement.
- 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.
- Targeting the hot spot in a patient with essential tremor and Parkinson's disease: Tractography matters(2018) LISTIKA, Clarice; SANTIAGO, Natally; REIS, Paul Rodrigo; GODINHO, Fabio; DUARTE, Kleber; TEIXEIRA, Manoel Jacobsen; BARBOSA, Egberto Reis; CURY, Rubens GisbertIntroduction: Thalamic ventralis intermedius deep brain stimulation (VIM-DBS) is generally effective in treating refractory tremor in Parkinson's disease (PD) and in essential tremor (ET), but some patients do not respond well due to side effects or from loss of the effect of stimulation over time. The caudal zona incerta (ZI) has emerged as a promising target in ET, and the effects of ZI-DBS on PD tremor are less studied. Here, we describe a rare situation in which both ET and PD coexist in a 72-year-old male referred for ZI-DBS due to refractory tremor. The aim of this study was to evaluate whether there was a difference in the area stimulated to improve each type of tremor and whether tractography could improve and predict motor outcome. Methods: Two months after the surgery, in order to define which of the cathodes was the most effective towards improving the tremor and parkinsonian symptoms, a double-blinded, monopolar evaluation was conducted on both hemispheres separately. Once the best contact and parameters were defined, the volume of tissue activation (VTA) was represented spatially for each type of tremor and, finally, the image model was fused with the tractography. Results: For both types of tremor, the hot spot stimulated region achieved the dentato-rubro-thalamic tract (DRTT) at the higher fiber density region. The DRTT fibers were asymmetrical between the right and left hemispheres. Conclusion: Regardless of the type of tremor, DRTT can be the most effective region for stimulation. Tractography should be considered when planning the surgical target since the DRTT is not always symmetrical, and the reconstruction of the VTA together with the tractography can greatly improve the DBS programming, and, probably, the patient's outcome to the stimulation.
- Celebrating thirty years of deep brain stimulation in movement disorders patients: A successful marriage between neurologists and neurosurgeons(2018) CURY, Rubens Gisbert; FRAIX, Valerie; MORO, Elena
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, RubensconferenceObject Successful Bilateral Subthalamic Nucleus Stimulation in Refractory Status Dystonicus(2018) CURY, Rubens; BARBOSA, Breno Jose Alencar Pires; CARRA, Rafael Bernhardt; DUARTE, Kleber Paiva; GODINHO, Fabio; CIAMPI, Daniel; TEIXEIRA, Manoel Jacobsen; BARBOSA, Egberto Reis- Association of Optic Pathways and Brain Structure With Deep Brain Stimulation of the Nucleus Basalis of Meynert for Parkinson Disease Dementia(2018) SANTOS, Diego de Castro dos; BARBOSA, Egberto Reis; CURY, Rubens Gisbert