Trabalho número 292, apresentação oral no XVII Congresso da Academia Brasileira de Neurocirurgia, Goiânia, 14 a 17 de junho de 2017. RESUMO Introdução:A distonia pode ser definida como um distúrbio neurológico com a presença de movimentos involuntários com contrações espasmódicas. A estimulação cerebral profunda (DBS) é considerada altamente efetiva em pacientes criteriosamente selecionados e avaliados. A maior efetividade da ECP é demonstrada principalmente nos casos de refratariedade do tratamento clínico e farmacológico na distonia cervical. Objetivo: realizar uma revisão de literatura comprando os resultados da Estimulação Cerebral Profunda no Globo Pálido Interno (GPi), analisando os resultados obtidos no tratamento da distonia focal e segmentar. Métodos: Foram pesquisados no banco de dados do MEDLINE artigos descrevendo DBS para distonia por meio de palavraschave. Resultados: Foram identificados 308 artigos que envolvem estudos no tratamento de distonia com DBS no GPi. Após aplicar os filtros na base de dados "MEDLINE", 48 artigos foram excluídos, restando 260 artigos elegíveis. Posteriormente, realizou-se uma revisão minuciosa dos artigos publicados na plataforma em questão. Conclusões: Aponta-se que pacientes com distonia primária são mais beneficiados pelo DBS quando eletrodos são inseridos na porção ventromedial do GPi com taxas de efeitos adversos aceitáveis. Um melhor prognóstico desses pacientes depende de um acompanhamento interdisciplinar individualizado no período pré e pós-operatório. ABSTRACT Introduction: Dystonia can be defined as a neurological disorder characterized by involuntary movements with spasmodic contractions. Deep brain stimulation (DBS) is considered highly effective in critically selected and evaluated patients. The greater effectiveness of DBS is demonstrated mainly in cases of clinical and pharmacological treatment of refractory cervical dystonia.Objective: This paper aims to review the literature comparing the results of the DBS at Globus Pallidus internus (GPi), analyzing the results obtained in the treatment of focal and segmental dystonia. Methods: We searched at MEDLINE database for articles describing DBS for dystonia using keywords. Results: We identified 308 articles involving studies in the treatment of dystonia with the GPi DBS. After applying filters in "MEDLINE" database, 48 articles were excluded, remaining 260 eligible articles. Subsequently, a thorough review of the articles published on this platform was carried out. Conclusions: it is pointed out that patients with primary dystonia are more benefited by DBS when electrodes are inserted in the ventromedial portion of the GPi with acceptable adverse effects rates. A better prognosis of these patients depends on an individualized interdisciplinary follow-up in the pre and postoperative period.

Background: The Complex Regional Pain Syndrome (CRPS), known as reflex sympathetic dystrophy, Sudeck atrophy, causalgy or posttraumatic pain has been described as an important cause of chronic morbidity, which acknowledge of clinical limits, pathophysiology and implications of pathogenesis is still little elucidated. Therefore a great dissatisfaction for patients and health professionals has been described regarding to the currently available therapeutic methods. Objectives: The goal of this paper is to discuss the current perspectives of physiopathology, diagnosis and treatment in CRPS. Methods: A review of the literature was carried out using the MEDLINE, LILACS, and SciELO databases, with preference to articles in English, Portuguese and Spanish. Results: The diagnosis is predominantly based in clinical evidences of signs and symptoms. Although it has been described in the literature in many studies and guidelines about the treatment of CRPS, there is no consensus of procedure indications. Between the surgical methods, the use of spinal cord stimulation and others neuromodulators approaches has been described associated to significant rates of success in the management of CRPS. Conclusion: According to the literature and authors experience, the successful treatment of CRPS is based in early diagnosis associated to experienced interdisciplinary team aiming the functional restoration and psychological aspect monitoring.