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
36 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 36
- Bilateral striatal lesion due to herpesvirus-6 infection(2015) CURY, Rubens Gisbert; LOPEZ, Willian Omar Contreras
- Use of non-invasive stimulation in movement disorders: a critical review(2021) GODEIRO, Clecio; FRANCA, Carina; CARRA, Rafael Bernhart; SABA, Felipe; SABA, Roberta; MAIA, Debora; BRANDAO, Pedro; ALLAM, Nasser; RIEDER, Carlos R. M.; FREITAS, Fernando Cini; CAPATO, Tamine; SPITZ, Mariana; FARIA, Danilo Donizete de; CORDELLINI, Marcela; VEIGA, Beatriz A. A. G.; ROCHA, Maria Sheila G.; MACIEL, Ricardo; MELO, Lucio B. De; MOLLER, Patricia D. S.; JUNIOR, Magno R. R.; FORNARI, Luis H. T.; MANTESE, Carlos E.; BARBOSA, Egberto Reis; MUNHOZ, Renato P.; COLETTA, Marcus Vinicius Della; CURY, Rubens GisbertBackground: Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders. Objective: In this critical review,we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date. Methods: A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease. Results: Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson's disease (PD).The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD. Conclusions: There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.
- Cerebellum as a possible target for neuromodulation after stroke(2018) FRANCA, Carina; ANDRADE, Daniel Ciampi de; TEIXEIRA, Manoel Jacobsen; CURY, Rubens Gisbert
- The Parkinson disease pain classification system: results from an international mechanism-based classification approach(2021) MYLIUS, Veit; LLORET, Santiago Perez; CURY, Rubens G.; TEIXEIRA, Manoel J.; BARBOSA, Victor R.; BARBOSA, Egberto R.; I, Larissa Moreira; LISTIK, Clarice; FERNANDES, Ana M.; VEIGA, Diogo de Lacerda; BARBOUR, Julio; HOLLENSTEIN, Nathalie; OECHSNER, Matthias; WALCH, Julia; BRUGGER, Florian; HAGELE-LINK, Stefan; BEER, Serafin; RIZOS, Alexandra; CHAUDHURI, Kallol Ray; BOUHASSIRA, Didier; LEFAUCHEUR, Jean-Pascal; TIMMERMANN, Lars; GONZENBACH, Roman; KAGI, Georg; MOELLER, Jens Carsten; ANDRADE, Daniel Ciampi dePain is a common nonmotor symptom in patients with Parkinson disease (PD) but the correct diagnosis of the respective cause remains difficult because suitable tools are lacking, so far. We developed a framework to differentiate PD- from non-PD-related pain and classify PD-related pain into 3 groups based on validated mechanistic pain descriptors (nociceptive, neuropathic, or nociplastic), which encompass all the previously described PD pain types. Severity of PD-related pain syndromes was scored by ratings of intensity, frequency, and interference with daily living activities. The PD-Pain Classification System (PD-PCS) was compared with classic pain measures (ie, brief pain inventory and McGill pain questionnaire [MPQ], PDQ-8 quality of life score, MDS-UPDRS scores, and nonmotor symptoms). 159 nondemented PD patients (disease duration 10.2 +/- 7.6 years) and 37 healthy controls were recruited in 4 centers. PD-related pain was present in 122 patients (77%), with 24 (15%) suffering one or more syndromes at the same time. PD-related nociceptive, neuropathic, or nociplastic pain was diagnosed in 87 (55%), 25 (16%), or 35 (22%), respectively. Pain unrelated to PD was present in 35 (22%) patients. Overall, PD-PCS severity score significantly correlated with pain's Brief Pain Inventory and MPQ ratings, presence of dyskinesia and motor fluctuations, PDQ-8 scores, depression, and anxiety measures. Moderate intrarater and interrater reliability was observed. The PD-PCS is a valid and reliable tool for differentiating PD-related pain from PD-unrelated pain. It detects and scores mechanistic pain subtypes in a pragmatic and treatment-oriented approach, unifying previous classifications of PD-pain.
- SLEEP DISORDER, CHOREA, AND DEMENTIA ASSOCIATED WITH IgLON5 ANTIBODIES(2015) SIMABUKURO, Mateus M.; SABATER, Lidia; ADONI, Tarso; CURY, Rubens Gisbert; HADDAD, Monica Santoro; MOREIRA, Camila Hohi; OLIVEIRA, Imam; BOAVENTURA, Mateus; ALVES, Rosana Cardoso; SOSTER, Leticia Azevedo; NITRINI, Ricardo; GAIG, Carles; SANTAMARIA, Joan; DALMAU, Josep; GRAUS, Francesc
- New developments for spinal cord stimulation(2021) CURY, Rubens Gisbert; MORO, ElenaSpinal cord stimulation (SCS) is a well-established therapy for the treatment of chronic neuropathic pain. Newer SCS waveforms have improved patient outcomes, leading to its increased utilization among many pain conditions. More recently, SCS has been used to treat some symptoms in several movement disorders because of its good profile tolerability and capacity to stimulate local and distant areas of the central nervous system. After the original experimental findings in animal models of Parkinson's disease (PD) in the late 2000s, several studies have reported the beneficial clinical effects of SCS stimulation on gait in PD patients. Additionally, the spinal cord has emerged as a potential therapeutic target to treat essential and orthostatic tremor, some forms of ataxia, and atypical parkinsonisms. In this chapter, we describe the most recent advances in SCS for pain and the rationale and potential mechanism of action of stimulating the spinal cord for treating movement disorders, focusing on its network modulation. We also summarize the main clinical studies performed to date as well as their limitations and future perspectives.
- Trigeminal nerve thickening in chronic inflammatory demyelinating polyneuropathy(2015) GUEDES, Bruno Fukelmann; CURY, Rubens Gisbert
- Exploring clinical outcomes in patients with idiopathic/inherited isolated generalized dystonia and stimulation of the subthalamic region(2023) LISTIK, Clarice; LAPA, Jorge Dornellys; CASAGRANDE, Sara Carvalho Barbosa; BARBOSA, Egberto Reis; IGLESIO, Ricardo; GODINHO, Fabio; DUARTE, Kleber Paiva; TEIXEIRA, Manoel Jacobsen; CURY, Rubens GisbertBackground Deep Brain Stimulation (DBS) is an established treatment option for refractory dystonia, but the improvement among the patients is variable. Objective To describe the outcomes of DBS of the subthalamic region (STN) in dystonic patients and to determine whether the volume of tissue activated (VTA) inside the STN or the structural connectivity between the area stimulated and different regions of the brain are associated with dystonia improvement. Methods The response to DBS was measured by the Burke-Fahn-Marsden Dystonia Rating Scale (BFM) before and 7 months after surgery in patients with generalized isolated dystonia of inherited/idiopathic etiology. The sum of the two overlapping STN volumes from both hemisphereswas correlated with the change in BFM scores to assess whether the area stimulated inside the STN affects the clinical outcome. Structural connectivity estimates between the VTA (of each patient) and different brain regions were computed using a normative connectome taken from healthy subjects. Results Five patients were included. The baseline BFM motor and disability subscores were 78.30 +/- 13.55 (62.00-98.00) and 20.60 +/- 7.80 (13.00-32.00), respectively. Patients improved dystonic symptoms, though differently. No relationships were found between the VTA inside the STN and the BFM improvement after surgery (p = 0.463). However, the connectivity between the VTA and the cerebellum structurally correlated with dystonia improvement (p = 0.003). Conclusions These data suggest that the volume of the stimulated STN does not explain the variance in outcomes in dystonia. Still, the connectivity pattern between the region stimulated and the cerebellum is linked to outcomes of patients.
- Transcutaneous magnetic spinal cord stimulation for freezing of gait in Parkinson's disease(2020) MENEZES, Janaina Reis; CARRA, Rafael Bernhart; NUNES, Glaucia Aline; SIMOES, Juliana da Silva; TEIXEIRA, Manoel Jacobsen; DUARTE, Kleber Paiva; ANDRADE, Daniel Ciampi de; BARBOSA, Egberto Reis; MARCOLIN, Marco Antonio; CURY, Rubens GisbertDopaminergic drugs partially alleviate gait problems in Parkinson's disease, but the effects are not sustained in the long-term. Particularly, the freezing of gait directly impacts patients' quality of life. Experimental epidural spinal cord stimulation (SCS) studies have suggested positive effects on locomotion among PD patients, but the effects of non-invasive stimulation have never been explored. Here, we investigated in a prospective, open-label, pilot study the efficacy and safety of non-invasive magnetic stimulation of the spinal cord in five patients with PD who experienced gait problems, including freezing of gait. A trial of transcutaneous magnetic SCS was performed at the level of the fifth thoracic vertebra. The primary outcome was the change in freezing of gait 7 days after stimulation. Secondary outcome measures included changes in gait speed and UPDRS part III. After non-invasive spinal cord stimulation, patients experienced a 22% improvement in freezing of gait (p = 0.040) and 17.4% improvement in the UPDRS part III (p = 0.042). Timed up and go times improved by 48.2%, although this did not reach statistical significance (p = 0.06). Patients' global impression of change was 'much improved' for four patients. Improvement in gait after stimulation was reversible, since it returned to baseline scores 4 weeks after stimulation. No severe side effects were recorded. This pilot study suggests that transcutaneous magnetic spinal cord stimulation is feasible and can potentially improve gait problems in PD, without severe adverse effects. Large scale phase II trials are needed to test this hypothesis.
- Gaps and roadmap of novel neuromodulation targets for treatment of gait in Parkinson's disease(2022) CURY, Rubens Gisbert; PAVESE, Nicola; KRAUSS, Joachim K.; MORO, ElenaGait issues in Parkinson's disease (PD) are common and can be highly disabling. Although levodopa and deep brain stimulation (DBS) of the subthalamic nucleus and the globus pallidus internus have been established therapies for addressing the motor symptoms of PD, their effects on gait are less predictable and not well sustained with disease progression. Given the high prevalence of gait impairment in PD and the limitations in currently approved therapies, there has been considerable interest in alternative neuromodulation targets and techniques. These have included DBS of pedunculopontine nucleus and substantia nigra pars reticulata, spinal cord stimulation, non-invasive modulation of cortical regions and, more recently, vagus nerve stimulation. However, successes and failures have also emerged with these approaches. Current gaps and controversies are related to patient selection, optimal electrode placement within the target, placebo effects and the optimal programming parameters. Additionally, recent advances in pathophysiology of oscillation dynamics have driven new models of closed-loop DBS systems that may or may not be applicable to gait issues. Our aim is to describe approaches, especially neuromodulation procedures, and emerging challenges to address PD gait issues beyond subthalamic nucleus and the globus pallidus internus stimulation.