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
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bookPart Dor em Afecções Neurológicas Especificas(2019) CURY, Rubens Gisbert; GAMELEIRA, Fernando Tenório; SILVA, Fernanda Valério da; LOPES, Laura Cardia Gomes; BARBOSA, Luciana Mendonça; ANDRADE, Daniel Ciampi Araujo de- Deep Brain Stimulation in Patients With Mutations in Parkinson's Disease-Related Genes: A Systematic Review(2019) OLIVEIRA, Lais Machado de; BARBOSA, Egberto Reis; AQUINO, Camila Catherine; MUNHOZ, Renato Puppi; FASANO, Alfonso; CURY, Rubens GisbertBackground Deep brain stimulation (DBS) is an effective treatment for Parkinson's disease (PD), and careful selection of candidates is a key component of successful therapy. Although it is recognized that factors such as age, disease duration, and levodopa responsiveness can influence outcomes, it is unclear whether genetic background should also serve as a parameter. Objectives The aim of this systematic review is to explore studies that have evaluated DBS in patients with mutations in PD-related genes. Methods We performed a selective literature search for articles regarding the effects of DBS in autosomal dominant or recessive forms of PD or in PD patients with genetic risk factors. Data regarding changes in motor and nonmotor scores and the presence of adverse events after the stimulation were collected. Results A total of 25 studies were included in the systematic review, comprising 135 patients. In the shorter term, most patients showed marked or satisfactory response to subthalamic DBS, although leucine rich repeat kinase 2 carriers of R114G mutations had higher rates of unsatisfactory outcome. Longer term follow-up data were scarce but suggested that motor benefit is sustained. Patients with the glucosidase beta acid (GBA) mutation showed higher rates of cognitive decline after surgery. Motor outcome was scarce for pallidal DBS. Few adverse events were reported. Conclusions Subthalamic DBS results in positive outcomes in the short term in patients with Parkin, GBA, and leucine-rich repeat kinase 2 (non-R144G) mutations, although the small sample size limits the interpretation of our findings. Longer and larger cohorts of follow-up, with broader nonmotor symptom evaluations will be necessary to better customize DBS therapy in this population.
- Effects of dentate nucleus stimulation in spinocerebellar ataxia type 3(2019) CURY, Rubens Gisbert; FRANCA, Carina; SILVA, Valquiria; BARBOSA, Egberto Reis; CAPATO, Tamine T. C.; LEPSKI, Guilherme; DUARTE, Kleber Paiva; TEIXEIRA, Manoel Jacobsen; ANDRADE, Daniel Ciampi de
- Deep brain stimulation in Tourette's syndrome: evidence to date(2019) CASAGRANDE, Sara C. B.; CURY, Rubens G.; ALHO, Eduardo J. L.; FONOFF, Erich TalamoniTourette's syndrome (TS) is a neurodevelopmental disorder that comprises vocal and motor tics associated with a high frequency of psychiatric comorbidities, which has an important impact on quality of life. The onset is mainly in childhood and the symptoms can either fade away or require pharmacological therapies associated with cognitive-behavior therapies. In rare cases, patients experience severe and disabling symptoms refractory to conventional treatments. In these cases, deep brain stimulation (DBS) can be considered as an interesting and effective option for symptomatic control. DBS has been studied in numerous trials as a therapy for movement disorders, and currently positive data supports that DBS is partially effective in reducing the motor and non-motor symptoms of TS. The average response, mostly from case series and prospective cohorts and only a few controlled studies, is around 40% improvement on tic severity scales. The ventromedial thalamus has been the preferred target, but more recently the globus pallidus internus has also gained some notoriety. The mechanism by which DBS is effective on tics and other symptoms in TS is not yet understood. As refractory TS is not common, even reference centers have difficulties in performing large controlled trials. However, studies that reproduce the current results in larger and multicenter randomized controlled trials to improve our knowledge so as to support the best target and stimulation settings are still lacking. This article will discuss the selection of the candidates, DBS targets and mechanisms on TS, and clinical evidence to date reviewing current literature about the use of DBS in the treatment of TS.
- Interleaving Stimulation in Parkinson Disease: Interesting to Whom?(2019) FRANCA, Carina; BARBOSA, Egberto Reis; IGLESIO, Ricardo; TEIXEIRA, Manoel Jacobsen; CURY, Rubens GisbertBACKGROUND: Interleaving stimulation (ILS) is a stim-ulation strategy that can help the physician manage more challenging cases of patients with deep brain stimulation (DBS) for Parkinson disease (PD). It consists of altering 2 different programs on the electrode with the same frequency. OBJECTIVES: Our objective was to overview our patients experience with ILS and explore clinical scenarios in which ILS should be considered when programming DBS in patients with PD. METHODS: We retrospectively reviewed medical charts from 120 patients with PD treated with DBS between 2011 and 2018. RESULTS: Eighteen patients received ILS. One was excluded because of the medical chart was incomplete. The remaining 17 patients had subthalamic nucleus DBS (n = 14) and globus pallidus internus DBS (n = 3). Eight patients (47%) received ILS to improve rigidity and bradykinesia, 4 to improve dyskinesias, 4 because of refractory tremor, and 1 for gait management. Until the end of data collection, 13 of 17 patients (70%) were still on ILS, with a mean duration time of 28.8 months (range, 2-44 months) Four patients reported no benefit from ILS and had their program changed. CONCLUSIONS: Overall, ILS is useful 1) to use 2 contacts optimally improve 2 specific symptoms but have different therapeutic windows; 2) to avoid side effects related to current spreading to nearby areas; 3) to increase frequency in a small region; or 4) to stimulate a larger target area.
- 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
conferenceObject GPi DBS does not affect sensory thresholds in hereditary/idiopathic dystonia(2019) LISTIK, C.; CURY, R. Gisbert; SILVA, V. da; CASAGRANDE, S. Carvalho Barbosa; LISTIK, E.; LINK, N.; GALHARDONI, R.; BARBOSA, E. Reis; TEIXEIRA, M. Jacobsen; ANDRADE, D. de- Exploring the clinical outcomes after deep brain stimulation in Tourette syndrome(2019) BRITO, Manuelina; TEIXEIRA, Manoel Jacobsen; MENDES, Matheus Miranda; FRANCA, Carina; IGLESIO, Ricardo; BARBOSA, Egberto Reis; CURY, Rubens GisbertIntroduction: Deep brain stimulation (DBS) of the thalamic centromedian-parafascicular (CM-Pf) region is the most common target to treat refractory Tourette syndrome (TS), but the improvement among the patients is quite variable. This study describes the outcomes of stimulation in TS patients and attempts to determine whether the volume of tissue activated (VTA) inside the thalamus or the structural connectivity between the area stimulated and different regions of the brain is associated with tic improvement. Methods: The DBS patient response was measured as the percentage change in the Yale Global Tic Severity Scale (YGTSS) before and 12 months after surgery. The sum of the two overlapping VTA/CM-Pf volumes from both hemispheres was correlated with the percent change in YGTSS scores to assess whether the area stimulated inside the CM-Pf affects the clinical outcome. Structural connectivity estimates between the VTA (of each patient) and different regions of the brain were computed using a normative connectome that was taken from healthy subjects. Results: Five male patients aged 26.8 +/- 9.3 years were included. No relationships were found between the areas stimulated and the changes in patient tics (p = .374). However, the right frontal middle gyms (R = 0.564, p =.03), the left frontal superior sulci region (R = 0.900, p =.030) and the left cingulate sulci region (R = 0.821, p = .045) structurally correlated with tic improvement. Conclusion: These data suggests that the volume of thalamic area that is stimulated does not explain the variance in outcomes in TS, however, the pattern of connectivity between the region stimulated and specific brain cortical areas is linked to patient outcome.
- Deep Brain Stimulation in Patients with Isolated Generalized Dystonia Caused by PRKRA Mutation(2019) CASAGRANDE, Sara Carvalho Barbosa; LISTIK, Clarice; COELHO, Daniel Boari; LIMONGI, Joao Carlos Papaterra; TEIXEIRA, Luis Augusto; TEIXEIRA, Manoel Jacobsen; BARBOSA, Egberto Reis; CURY, Rubens GisbertView Supplementary Video 1