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Vol. 22. Issue 1.
Pages 5-22 (January 2011)
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Vol. 22. Issue 1.
Pages 5-22 (January 2011)
Dianas quirúrgicas en el tratamiento de enfermedades psiquiátricas. Desde el movimiento a las emociones
Surgical targets in Psychiatric disorders. From movement to emotions
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J. Guridi
Corresponding author
jguridi@unav.es

Correspondencia. Servicio de Neurocirugía. Clínica Universidad de Navarra. Pio XII sn. 31008 Pamplona.
, G. Aldave
Servicio de Neurocirugía. Clínica Universidad de Navarra. Pamplona. España
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Resumen

La estimulación cerebral profunda para las enfermedades psiquiátricas que son refractarias a los distintos tratamientos convencionales, se está realizando actualmente debido en gran parte a los conocimientos adquiridos en la cirugía para los trastornos del movimiento, sobre todo la enfermedad de Parkinson (EP). La depresión, los trastornos obsesivo-compulsivos (TOC) y el síndrome de Gilles de la Tourette son problemas córtico-estriato-tálamo-corticales relacionados con los circuitos límbicos de los ganglios basales.

En esta revisión se analizan las distintas dianas quirúrgicas para las diferentes patologías neuro-psiquiátricas. Para el TOC actualmente existen dos dianas, el complejo estriado ventral (VS)-núcleo accumbens (Nacc) y el núcleo subtalámico (NST). Para la depresión refractaria, el área subgenual (área 25 de Brodmann) y el VS/Nacc. Para el Tourette, el ventralis oralis interno y centromediano parafascicularis (Voi, CM/Pf) del tálamo y el globo pálido interno (GPi). En la actualidad no existe una única diana específica en cualquiera de las patologías, ya que los resultados clínicos tras la estimulación pueden considerarse similares. Por otro lado, una misma diana quirúrgica puede mejorar diferentes patologías.

Palabras clave:
Estimulación cerebral profunda
Enfermedad de Parkinson
Trastorno obsesivo-compulsivo
Gilles de la Tourette
Depresión
Abreviaturas:
AMS
CA
rCBF
CCA
CI
CM/Pf
COF
DA
DBS
DM
EP
GB
GPe
GPi
HDRS
ICD
Nacc
NST
PET
SGT
SNc
SNr
TEC
TOC
Voi
VS
Summary

Deep brain stimulation (DBS) for psychiatric disorders refractory to conventional treatments are currently been performed based in the knowledgment obtained in the motor disorder surgery and mainly in Parkinson's disease. Depression, obsessive-compulsive disorder (OCD) and Tourette syndrome, all of them are cortico-striato-thalamo-cortical pathological process involved in the limbic loop of the basal ganglia.

This review describes the different targets in these pathological neuro-psychiatric disorders. For OCD there are currently two targets, ventral striatum (VS) Accumbens nucleus (Nacc) and the subthalamic nucleus (STN). In refractory depression the subgenual area (25 Brodmann area) and VS/Nacc. For Tourette syndrome the ventralis oralis internus and centromedianum/parafascicularis of the thalamus (Voi and CM/Pf) and the internal part of the globus pallidus (GPi). Currently there are no specific surgical target for each pathological disorder because clinical results reported are very similar after stimulation surgery. In other point, a selected surgical target also may improve different pathologies.

Key words:
Deep brain stimulation
Parkinson's disease
Obsessive-compulsive disorder
Tourette syndrome
Depression

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