TRATAMENTO CIRÚRGICO PARA A DOENÇA DE ALZHEIMER: UMA NOVA PERSPECTIVA
DOI:
https://doi.org/10.47820/recima21.v5i12.6039Palavras-chave:
Doença de Alzheimer, Saúde, Estimulação Cerebral ProfundaResumo
A Estimulação Cerebral Profunda (ECP) é uma técnica neurocirúrgica segura e promissora para o tratamento da Doença de Alzheimer (DA), uma condição neurodegenerativa prevalente em idosos. Este artigo revisa a aplicação da ECP em alvos específicos do cérebro, como o fórnix, o córtex entorrinal (CE), o núcleo basal de Meynert (NBM) e os núcleos talâmicos. Os estudos analisados mostram que a ECP pode melhorar o metabolismo cerebral, reduzir a inflamação e estabilizar o declínio cognitivo, resultando em melhorias na qualidade de vida dos pacientes. Embora os resultados sejam promissores, a variabilidade nas respostas sugere a necessidade de personalização dos parâmetros de estimulação e mais pesquisas para otimizar essa abordagem terapêutica.
Downloads
Referências
1. Arulchelvan E, Vanneste S. Promising neurostimulation routes for targeting the hippocampus to improve episodic memory: A review. Brain Research [Internet]. 2023 Sep 1;1815. Available from: https://www.sciencedirect.com/science/article/pii/S0006899323002287?via%3Dihub DOI: https://doi.org/10.1016/j.brainres.2023.148457
2. Auld DS, Kornecook TJ, Bastianetto S, Quirion R. Alzheimer’s disease and the basal forebrain cholinergic system: relations to beta-amyloid peptides, cognition, and treatment strategies. Progress in Neurobiology [Internet]. 2002 Oct 1 [cited 2024];68(3):209–45. Available from: https://pubmed.ncbi.nlm.nih.gov/12450488/ DOI: https://doi.org/10.1016/S0301-0082(02)00079-5
3. Barcia JA, Viloria MA, Yubero R, Sanchez-Sanchez-Rojas L, López A, Strange BA, et al. Directional DBS of the Fornix in Alzheimer’s Disease Achieves Long-Term Benefits: A Case Report. Frontiers in Aging Neuroscience [Internet]. 2022 Apr 1;14. Available from: https://doi.org/10.3389%2Ffnagi.2022.809972 DOI: https://doi.org/10.3389/fnagi.2022.809972
4. Bartus RT, Emerich DF. Cholinergic Markers in Alzheimer Disease. JAMA [Internet]. 1999 Dec 15 [cited 2024];282(23):2208–9. Available from: https://jamanetwork.com/journals/jama/article-abstract/1030484 DOI: https://doi.org/10.1001/jama.282.23.2208
5. Bowirrat A, Ashkenazi S, Bowirrat A, Pinhasov A. Does the Application of Deep Brain Stimulation to Modulate Memory and Neural Circuity in AD Hold Substantial Promise? Neuroscience Bulletin. 2022 Jan 20;38(5):553–7. DOI: https://doi.org/10.1007/s12264-021-00815-4
6. Brion JP, Anderton BH, Authelet M, Dayanandan R, Leroy K, Lovestone S, et al. Neurofibrillary tangles and tau phosphorylation. Biochem Soc Symp [Internet]. 2001 [cited 2024];(67):81–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11447842 DOI: https://doi.org/10.1042/bss0670081
7. Deeb W, Salvato B, Almeida L, Foote KD, Amaral R, Germann J, et al. Fornix-Region Deep Brain Stimulation–Induced Memory Flashbacks in Alzheimer’s Disease. New England Journal of Medicine [Internet]. 2019 Aug 22 [cited 2023];381(8):783–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313538/ DOI: https://doi.org/10.1056/NEJMc1905240
8. Germann J, Elias GJB, Boutet A, Narang K, Neudorfer C, Horn A, et al. Brain structures and networks responsible for stimulation‐induced memory flashbacks during forniceal deep brain stimulation for Alzheimer’s disease. Alzheimer’s & Dementia [Internet]. 2021 Jan 21 [cited 2024];17(5):777–87. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247976/ DOI: https://doi.org/10.1002/alz.12238
9. Hardy J, Selkoe DJ. The amyloid hypothesis of Alzheimer’s disease: progress and problems on the road to therapeutics. Science (New York, NY) [Internet]. 2002;297(5580):353–6. Available from: https://www.science.org/doi/abs/10.1126/science.1072994 DOI: https://doi.org/10.1126/science.1072994
10. Hescham S, Aldehri M, Temel Y, Alnaami I, Jahanshahi A. Deep brain stimulation for Alzheimer’s Disease: An update. Surgical Neurology International [Internet]. 2018 [cited 2023];9(1):58. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858049/ DOI: https://doi.org/10.4103/sni.sni_342_17
11. Jakobs M, Lee DJ, Lozano AM. Modifying the progression of Alzheimer’s and Parkinson’s disease with deep brain stimulation. Neuropharmacology [Internet]. 2020 Jul [cited 2023 Feb];171(107860). Available from: https://www.sciencedirect.com/science/article/abs/pii/S0028390819304265?via%3Dihub DOI: https://doi.org/10.1016/j.neuropharm.2019.107860
12. Jiang Y, Yuan T, Chen Y, Guo P, Lian T, Liu Y, et al. Deep brain stimulation of the nucleus basalis of Meynert modulates hippocampal–frontoparietal networks in patients with advanced Alzheimer’s disease. Translational neurodegeneration [Internet]. 2022 Dec 5;11(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9721033/ DOI: https://doi.org/10.1186/s40035-022-00327-9
13. Krauss JK, Lipsman N, Aziz T, Boutet A, Brown P, Chang JW, et al. Technology of deep brain stimulation: current status and future directions. Nature Reviews Neurology [Internet]. 2020 Nov 26 [cited 2023 Feb 18];17(2):1–13. Available from: https://www.nature.com/articles/s41582-020-00426-z#citeas
14. Lin W, Bao WQ, Ge JJ, Yang LK, Ling ZP, Xu X, et al. Forniceal deep brain stimulation in severe Alzheimer’s disease: A case report. World Journal of Clinical Cases. 2020 Oct 26;8(20):4938–45. DOI: https://doi.org/10.12998/wjcc.v8.i20.4938
15. Machado ABM, Haertel LM. Neuroanatomia funcional. 3rd ed. São Paulo: Atheneu; 2014.
16. Bear MF, Connors BW, Paradiso MA. Neurociências Desvendando O Sistema Nervoso. 4th ed. Porto Alegre: Artmed; 2017.
17. Nassehi B, Kocabicak E, Temel Y, Hescham S. The alteration of neurogenesis and pathological markers in alzheimer’s disease after deep brain stimulation. Turkish Neurosurgery [Internet]. 2022 [cited 2023];32(4):535–48. Available from: https://www.turkishneurosurgery.org.tr/pdf/pdf_JTN_2647.pdf
18. National Institute on Aging. What Are the Signs of Alzheimer’s Disease? [Internet]. National Institute on Aging. 2022 [cited 2023]. Available from: https://www.nia.nih.gov/health/alzheimers-symptoms-and-diagnosis/what-are-signs-alzheimers-disease
19. Nazmuddin M, Philippens IHCHM, van Laar T. Electrical stimulation of the nucleus basalis of meynert: a systematic review of preclinical and clinical data. Scientific Reports [Internet]. 2021 Jun 3;11(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175342/ DOI: https://doi.org/10.1038/s41598-021-91391-0
20. Ning S, Jorfi M, Patel SR, Kim DY, Tanzi RE. Neurotechnological Approaches to the Diagnosis and Treatment of Alzheimer’s Disease. Frontiers in Neuroscience [Internet]. 2022 Mar 24;16:854992. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8989850/ DOI: https://doi.org/10.3389/fnins.2022.854992
21. Peng S, Dhawan V, Eidelberg D, Ma Y. Neuroimaging evaluation of deep brain stimulation in the treatment of representative neurodegenerative and neuropsychiatric disorders. Bioelectronic Medicine. 2021 Mar 30;7(1). DOI: https://doi.org/10.1186/s42234-021-00065-9
22. Ribeiro HF, Dos Santos JSF, De Souza JN. Doença de Alzheimer de início precoce (DAIP): características neuropatológicas e variantes genéticas associadas. Revista de Neuro-Psiquiatria [Internet]. 2021 Aug 9 [cited 2023];84(2):113–27. Available from: http://www.scielo.org.pe/scielo.php?pid=S0034-85972021000200113&script=sci_arttext DOI: https://doi.org/10.20453/rnp.v84i2.3998
23. Ríos AS, Oxenford S, Neudorfer C, Butenko K, Li N, Rajamani N, et al. Optimal deep brain stimulation sites and networks for stimulation of the fornix in Alzheimer’s disease. Nature Communications [Internet]. 2022 Dec 14 [cited 2023 Feb 3];13(1):7707. Available from: https://www.nature.com/articles/s41467-022-34510-3 DOI: https://doi.org/10.1038/s41467-022-34510-3
24. Selkoe DJ. Alzheimer’s Disease: Genes, Proteins, and Therapy. Physiological Reviews [Internet]. 2001 Apr 1 [cited 2023];81(2):741–66. Available from: https://journals.physiology.org/doi/full/10.1152/physrev.2001.81.2.741?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org DOI: https://doi.org/10.1152/physrev.2001.81.2.741
25. Senevirathne DKL, Mahboob A, Zhai K, Paul P, Kammen A, Lee DJ, et al. Deep Brain Stimulation beyond the Clinic: Navigating the Future of Parkinson’s and Alzheimer’s Disease Therapy. Cells [Internet]. 2023 Jan 1;12(11):1478. Available from: https://www.mdpi.com/2073-4409/12/11/1478 DOI: https://doi.org/10.3390/cells12111478
26. Senova S, Fomenko A, Gondard E, Lozano AM. Anatomy and function of the fornix in the context of its potential as a therapeutic target. Journal of Neurology, Neurosurgery & Psychiatry [Internet]. 2020 Mar 4;91(5):547–59. Available from: https://jnnp.bmj.com/content/91/5/547 DOI: https://doi.org/10.1136/jnnp-2019-322375
27. Sereniki A, Vital MABF. A doença de Alzheimer: aspectos fisiopatológicos e farmacológicos. Revista de Psiquiatria do Rio Grande do Sul [Internet]. 2008;30(1). Available from: http://www.scielo.br/scielo.php?pid=S0101-81082008000200002&script=sci_arttext&tlng=pt DOI: https://doi.org/10.1590/S0101-81082008000200002
28. Smith GS, Laxton AW, Tang-Wai DF, McAndrews MP, Diaconescu AO, Workman CI, et al. Increased cerebral metabolism after 1 year of deep brain stimulation in Alzheimer disease. Archives of Neurology [Internet]. 2012 [cited 2023 Feb];69(9):1141–8. Available from: https://pubmed.ncbi.nlm.nih.gov/22566505/ DOI: https://doi.org/10.1001/archneurol.2012.590
29. Subramaniam S, Blake DT, Constantinidis C. Cholinergic Deep Brain Stimulation for Memory and Cognitive Disorders. Journal of Alzheimer’s Disease [Internet]. 2021 Sep 14;83(2):491–503. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8543284/ DOI: https://doi.org/10.3233/JAD-210425
30. Torres KCL, Santos RR, Mapa FC, Moraes FL, Moraes EN, Silva MAR. Biomarkers in Alzheimer Disease. Geriatrics, Gerontology and Aging [Internet]. 2012 [cited 2023 Feb 18];6(3):273–82. Available from: https://ggaging.com/details/191/pt-BR/biomarcadores-na-doenca-de-alzheimer
31. Yang X, Zhang R, Sun Z, Kurths J. Controlling Alzheimer’s Disease Through the Deep Brain Stimulation to Thalamic Relay Cells. Front Comput Neurosci [Internet]. 2021;15:636770. Available from: https://pubmed.ncbi.nlm.nih.gov/34819845/ DOI: https://doi.org/10.3389/fncom.2021.636770
32. Yu D, Yan H, Zhou J, Yang X, Lu Y, Han Y. A circuit view of deep brain stimulation in Alzheimer’s disease and the possible mechanisms. Molecular Neurodegeneration [Internet]. 2019 Aug 8 [cited 2023 Feb];14(1). Available from: https://molecularneurodegeneration.biomedcentral.com/articles/10.1186/s13024-019-0334-4 DOI: https://doi.org/10.1186/s13024-019-0334-4
33. Yu XG, Mao ZQ, Wang X, Xu X, Cui ZQ, Pan LS, et al. Partial improvement in performance of patients with severe Alzheimer’s disease at an early stage of fornix deep brain stimulation. Neural Regeneration Research [Internet]. 2018 [cited 2024];13(12):2164. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199932/ DOI: https://doi.org/10.4103/1673-5374.241468
34. Yuan TF, Li WG, Zhang C, Wei H, Sun S, Xu NJ, et al. Targeting neuroplasticity in patients with neurodegenerative diseases using brain stimulation techniques. Translational Neurodegeneration [Internet]. 2020 Dec;9(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720463/ DOI: https://doi.org/10.1186/s40035-020-00224-z
35. Zhang W, Liu W, Patel B, Chen Y, Wang K, Yang A, et al. Case Report: Deep Brain Stimulation of the Nucleus Basalis of Meynert for Advanced Alzheimer’s Disease. Frontiers in Human Neuroscience [Internet]. 2021;15:645584. Available from: https://pubmed.ncbi.nlm.nih.gov/34122027/ DOI: https://doi.org/10.3389/fnhum.2021.645584
Downloads
Publicado
Licença
Direitos de Autor (c) 2024 RECIMA21 -Revista Científica Multidisciplinar - ISSN 2675-6218
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Os direitos autorais dos artigos/resenhas/TCCs publicados pertecem à revista RECIMA21, e seguem o padrão Creative Commons (CC BY 4.0), permitindo a cópia ou reprodução, desde que cite a fonte e respeite os direitos dos autores e contenham menção aos mesmos nos créditos. Toda e qualquer obra publicada na revista, seu conteúdo é de responsabilidade dos autores, cabendo a RECIMA21 apenas ser o veículo de divulgação, seguindo os padrões nacionais e internacionais de publicação.
