RAQUEL CHACON RUIZ MARTINEZ

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Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina

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  • article 37 Citação(ões) na Scopus
    Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease
    (2020) DAFSARI, Haidar S.; GHILARDI, Maria Gabriela dos Santos; VISSER-VANDEWALLE, Veerle; RIZOS, Alexandra; ASHKAN, Keyoumars; SILVERDALE, Monty; EVANS, Julian; MARTINEZ, Raquel C. R.; CURY, Rubens G.; JOST, Stefanie T.; BARBE, Michael T.; FINK, Gereon R.; ANTONINI, Angelo; RAY-CHAUDHURI, K.; MARTINEZ-MARTIN, Pablo; FONOFF, Erich Talamoni; TIMMERMANN, Lars
    Background: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects. Objective: To compare nonmotor effects of STN-DBS and GPi-DBS. Methods: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. Results: In both groups, PDQ UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. Conclusions: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles. (C) 2020 The Author(s).
  • article 16 Citação(ões) na Scopus
    Intraoperative Dopamine Release During Globus Pallidus Internus Stimulation in Parkinson's Disease
    (2013) MARTINEZ, Raquel C. R.; HAMANI, Clement; CARVALHO, Milene Cristina de; OLIVEIRA, Amanda Ribeiro de; ALHO, Eduardo; NAVARRO, Jessie; GHILARDI, Maria Gabriela dos Santos; BOR-SENG-SHU, Edson; HEINSEN, Helmut; OTOCH, Jose Pinhata; BRANDAO, Marcus Lira; BARBOSA, Egberto Reis; TEIXEIRA, Manoel Jacobsen; FONOFF, Erich Talamoni
    BackgroundIt is still unclear whether dopamine (DA) levels correlate with Parkinson's disease (PD) severity or play a role in the mechanisms of high-frequency stimulation (HFS). MethodsWe have used microdialysis to record pallidal DA in 5 patients with PD undergoing microelectrode-guided pallidotomy. ResultsWe found that patients with more severe disease and, consequently, lower pallidal DA did poorly after pallidal lesions. In the operating room, 4 of 5 patients had a significant increase in DA levels during HFS (600%, on average). To test the hypothesis that DA was important for the effects of stimulation, we correlated the amelioration in rigidity observed in the operating room with pallidal DA release. Though rigidity was 56% better during stimulation, no correlation was found between such an improvement and DA release. ConclusionsThese findings suggest that additional mechanisms not directly dependent on pallidal DA release may be involved in the clinical effects of HFS of the globus pallidus internus. (c) 2013 International Parkinson and Movement Disorder Society