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
130 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 130
- 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.
- Guidelines for Parkinson's disease treatment consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology- motor symptoms(2022) SABA, Roberta Arb; MAIA, Debora Palma; CARDOSO, Francisco Eduardo Costa; BORGES, Vanderci; ANDRADE, Luiz Augusto F.; FERRAZ, Henrique Ballalai; BARBOSA, Egberto Reis; RIEDER, Carlos Roberto de Mello; SILVA, Delson Jose da; CHIEN, Hsin Fen; CAPATO, Tamine; ROSSO, Ana Lucia; LIMA, Carlos Frederico Souza; BEZERRA, Jose Marcelo Ferreia; NICARETTA, Denise; BARSOTTINI, Orlando Graziani Povoas; GODEIRO-JUNIOR, Clecio; BARCELOS, Lorena Broseghini; CURY, Rubens Gisbert; SPITZ, Mariana; SILVA, Sonia Maria Cesar Azevedo; COLLETTA, Marcus Vinicius DellaThe treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.
- Bilateral striatal lesion due to herpesvirus-6 infection(2015) CURY, Rubens Gisbert; LOPEZ, Willian Omar Contreras
- Should the Globus Pallidus Targeting Be Refined in Dystonia?(2022) LAPA, Jorge Dornellys da Silva; GODINHO, Fabio Luiz Franceschi; TEIXEIRA, Manoel Jacobsen; LISTIK, Clarice; IGLESIO, Ricardo Ferrareto; DUARTE, Kleber Paiva; CURY, Rubens GisbertBackground and Study Aims Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a highly effective therapy for primary generalized and focal dystonias, but therapeutic success is compromised by a nonresponder rate of up to 20%. Variability in electrode placement and in tissue stimulated inside the GPi may explain in part different outcomes among patients. Refinement of the target within the pallidal area could be helpful for surgery planning and clinical outcomes. The objective of this study was to discuss current and potential methodological (somatotopy, neuroimaging, and neurophysiology) aspects that might assist neurosurgical targeting of the GPi, aiming to treat generalized or focal dystonia. Methods We selected published studies by searching electronic databases and scanning the reference lists for articles that examined the anatomical and electrophysiologic aspects of the GPi in patients with idiopathic/inherited dystonia who underwent functional neurosurgical procedures. Results The sensorimotor sector of the GPi was the best target to treat dystonic symptoms, and was localized at its lateral posteroventral portion. The effective volume of tissue activated (VTA) to treat dystonia had a mean volume of 153mm (3) in the posterior GPi area. Initial tractography studies evaluated the close relation between the electrode localization and pallidothalamic tract to control dystonic symptoms. Regarding the somatotopy, the more ventral, lateral, and posterior areas of the GPi are associated with orofacial and cervical representation. In contrast, the more dorsal, medial, and anterior areas are associated with the lower limbs; between those areas, there is the representation of the upper limb. Excessive pallidal synchronization has a peak at the theta band of 3 to 8Hz, which might be responsible for generating dystonic symptoms. Conclusions Somatotopy assessment of posteroventral GPi contributes to target-specific GPi sectors related to segmental body symptoms. Tractography delineates GPi output pathways that might guide electrode implants, and electrophysiology might assist in pointing out areas of excessive theta synchronization. Finally, the identification of oscillatory electrophysiologic features that correlate with symptoms might enable closed-loop approaches in the future.
conferenceObject Non-motor symptoms in PD candidates for DBS treatment(2016) GHILARDI, M. G. dos Santos; MARTINEZ, R. C. R.; CURY, R. G.; ARANHA, J. R.; TEIXEIRA, M. J.; BARBOSA, E. R.; FONOFF, E. T.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- 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.
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- Non-motor effects of deep brain stimulation in Parkinson?s disease motor subtypes(2023) JOST, Stefanie T.; KONITSIOTI, Agni; LOEHRER, Philipp A.; ASHKAN, Keyoumars; RIZOS, Alexandra; SAUERBIER, Anna; GHILARDI, Maria Gabriela dos Santos; ROSENKRANZ, Franz; STROBEL, Lena; GRONOSTAY, Alexandra; BARBE, Michael T.; EVANS, Julian; VISSER-VANDEWALLE, Veerle; NIMSKY, Christopher; FINK, Gereon R.; SILVERDALE, Monty; CURY, Rubens G.; FONOFF, Erich T.; ANTONINI, Angelo; CHAUDHURI, K. Ray; TIMMERMANN, Lars; MARTINEZ-MARTIN, Pablo; DAFSARI, Haidar S.Introduction: Deep brain stimulation (DBS) is a well-established treatment for patients with Parkinson's disease (PD) improving quality of life, motor, and non-motor symptoms. However, non-motor effects in PD subtypes are understudied. We hypothesized that patients with 'postural instability and gait difficulty' (PIGD) experience more beneficial non-motor effects than 'tremor-dominant' patients undergoing DBS for PD.Methods: In this prospective, observational, international multicentre study with a 6-month follow-up, we assessed the Non-Motor Symptom Scale (NMSS) as primary and the following secondary outcomes: Unified PD Rating Scale-motor examination (UPDRS-III), Scales for Outcomes in PD (SCOPA)-activities of daily living (ADL) and-motor complications, PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose (LEDD). We analysed within-group longitudinal changes with Wilcoxon signed-rank test and Benjamini-Hochberg correction for multiple comparisons. Additionally, we explored outcome between-group differences of motor subtypes with Mann-Whitney U-tests.Results: In 82 PIGD and 33 tremor-dominant patients included in this study, baseline NMSS total scores were worse in PIGD patients, both groups experienced postoperative improvements of the NMSS sleep/fatigue domain, and between-group differences in postoperative outcomes were favourable in the PIGD group for the NMSS total and miscellaneous domain scores.Conclusions: This study provides evidence of a favourable outcome of total non-motor burden in PIGD compared to tremor-dominant patients undergoing DBS for PD. These differences of clinical efficacy on non-motor aspects should be considered when advising and monitoring patients with PD undergoing DBS.
- 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.