It is the second most common neurodegenerative disease after Alzheimer and one of those that most limits autonomy. Specialists warn that its constant advance could make it one of the great challenges of public health in the coming decades.
This scenario makes it essential to have treatments capable of sustaining mobility when the medication stops working.
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Neurosurgeon Pablo Andrés Mortarino with his team, doctors Tomás De la Riestra, María Eugenia Ferri and Mauricio Chamorro.
The Deep Brain Stimulation, A procedure that emerged in the 80s, is one of the most effective tools to improve the quality of life of people with Parkinson’s when the medication begins to lose effect.
The neurosurgeon Pablo Andrés Mortarinoa member of the Department of Functional and Stereotactic Neurosurgery at the Sanatorio Parque de Rosario and professional at the Clemente Álvarez Emergency Hospital, explains the procedure with a simple image. “It is very similar to a cardiac pacemaker, but aimed at the brain”he points out in an interview with AIRE.
What does the intervention that improves quality of life consist of?
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The intervention consists of placing a very fine electrode in a deep affected area. This electrode reproduces the effect that the medication offers during the first years, when the patient lives his “honeymoon” with drugs.
Over time, this stage shortens and fluctuations appear: brief moments of good mobility that are interspersed with others of strong rigidity. “We can reproduce that effect and make it last over time, long beyond the honeymoon,” explains the neurosurgeon.
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The intervention consists of placing a very fine electrode in a deep affected area.
Although the disease is not curable, surgery can slow the progression of some symptoms. That is why the indications have changed in the last ten or fifteen years, always in the same direction: the sooner the better.
“Once the requirements were met, it was more convenient not to delay the indication so that this slowing occurs in earlier stages. When the disease has advanced too much, the surgery no longer has the effect it could have had before,” he clarifies.
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Last year the team performed more than twenty surgeries for Parkinson’s alone. Three of these procedures were carried out in the public sector. The goal is to expand access with the support of the hospital and provincial institutions. The team is made up of Mortarino and doctors Tomás De la Riestra, María Eugenia Ferri and Mauricio Chamorro.
Who can have surgery and who cannot
Mortarino is clear. “It’s not for all patients.” The first thing is that the person is followed by a neurologist specializing in Parkinson’s. In Santa Fe, he points out, “there are highly trained professionals with experience in pharmacological management.” This follow-up is key, because surgery is only considered when the initial response to medication, which is usually very good, begins to fragment.
The central indicator is fluctuations. “The patient notices that at times of the day they have a very good response, but of short duration, which is followed by periods with a very poor response. The dose increases and that generates adverse effects,” he explains. Surgery allows these oscillations to be stabilized.
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Age is no longer a rigid limit. Before, surgery was performed until the age of 65, then until the age of 70. Today, biological age weighs.
There are clear contraindications: use of anticoagulants that cannot be suspended, brain pathologies that prevent the electrodes from being placed, or severe uncompensated psychiatric disorders. That is why the selection process includes an interdisciplinary evaluation with a psychiatrist, neuropsychologist and neurologist specializing in abnormal movements. “We are very strict because the success of the treatment is at stake here. The prior evaluation is as important as the surgery itself,” he says.
Age is no longer a rigid limit. Before, surgery was performed until the age of 65, then until the age of 70. Today, biological age weighs. “There are 70-year-old patients in optimal health, better candidates than others in their 50s with very aggressive juvenile Parkinson’s,” he points out.
What happens after surgery?
Each patient evolves differently, but the objective is clear: sustain quality of life when the disease begins to advance. “The reality is that not all symptoms are the same. The indications changed because we noticed that surgery can slow the progression of certain symptoms, and that is more beneficial if it is done sooner,” explains Mortarino.
Technology is advancing towards systems capable of being programmed remotely, something especially useful for a large province like Santa Fe. “It would be an excellent tool for patients who do not have the accessibility of those who live in larger cities,” he maintains.
There are also lines of research that seek to reproduce the effects of surgery without having to make a cut in the skin. While they still do not match the effectiveness of traditional neuromodulation, they represent an option for people with surgical contraindications.
Training and joint work
Mortarino trained at multiple centers, including Toronto Western in Canada. He particularly thanks Dr. Forte Mandoi, functional neurologist at the Favaloro Foundation, for his constant support in the development of these techniques.
In addition to the Sanatorium Park and the HECAthe team collaborates with professionals from the Hospital Iturraspe and of Cemafewhere they work in pain units that use similar devices. The common goal is to expand access to technologies that concretely improve patients’ lives.
The recognition
For his contribution to these surgeries, Mortarino was awarded a Diploma of Honor by the Chamber of Deputies of Santa Fe. The president of the body, Clara García, presented the recognition in a ceremony held on the esplanade of the Legislative Palace. The neurosurgeon admits that the surprise was great. “It was very nice, I didn’t expect it. The nomination came through a patient who shared his experience,” he says.
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For his contribution to these surgeries, Mortarino was awarded a Diploma of Honor by the Chamber of Deputies of Santa Fe.
Even so, he insists that merit is not individual. “We are a team and we are all equally important.” For him, the distinction works as support to continue advancing towards a central objective: that more and more people with Parkinson’s, regardless of their coverage or place of residence, can access top-level treatment.
