Parkinson's disease: neurological manifestations and possibilities for neurosurgery

Resumo

Parkinson's disease is caused by the progressive degeneration of nerve cells that produce dopamine, a neurotransmitter essential for motor coordination. The most common symptoms of Parkinson's disease are resting tremors, muscle rigidity, slow voluntary movements and postural instability. Furthermore, the disease can cause cognitive, emotional, sensory and autonomic changes. There are two main types of neurosurgery for Parkinson's disease: ablative surgery and deep brain stimulation (DBS). Objective: to evaluate the impact of neurosurgery for Parkinson's disease in improving motor symptoms, reducing medication side effects, preserving cognitive functions and improving patients' quality of life. Methodology: followed the PRISMA checklist. The databases used were PubMed, Scielo, Web of Science and Google Scholar. The descriptors used were: “Parkinson's disease”, “neurosurgery”, “ablation”, “deep brain stimulation” and “outcome”. The inclusion criteria were: articles that compared the two types of neurosurgery for Parkinson's disease (ablative surgery and deep brain stimulation), that evaluated clinical outcomes (motor symptoms, medication side effects, cognitive functions and quality of life) and that used standardized scales to measure these outcomes. The exclusion criteria were: articles that did not compare the two types of neurosurgery for Parkinson's disease, that did not evaluate the clinical outcomes of interest, that used non-validated or inadequate scales to measure these outcomes. Results: 15 studies were selected. Both types of neurosurgery for Parkinson's disease have been effective in improving patients' motor symptoms, especially tremors, rigidity, and bradykinesia. However, deep brain stimulation had an advantage over ablative surgery in terms of reducing medication side effects, such as motor fluctuations and dyskinesias. Deep brain stimulation was also safer and less invasive than ablative surgery, presenting fewer complications such as hemorrhage, infection, neurological deficits, and cognitive or psychiatric changes. However, deep brain stimulation showed greater improvement than ablative surgery, especially in physical, emotional and social aspects of quality of life. Conclusion: neurosurgery for Parkinson's disease is a valid therapeutic option for patients who do not respond adequately to drug treatment or who have intolerable side effects. Among the two main types of neurosurgery for Parkinson's disease, deep brain stimulation appears to be superior to ablative surgery in terms of efficacy, safety, and impact on patients' quality of life.