{"id":20266,"date":"2025-11-12T19:50:19","date_gmt":"2025-11-12T19:50:19","guid":{"rendered":"https:\/\/cancercentertec100.com\/?p=20266"},"modified":"2025-11-12T19:51:13","modified_gmt":"2025-11-12T19:51:13","slug":"radiocirugia_parkinson","status":"publish","type":"post","link":"https:\/\/cancercentertec100.com\/en\/investigacion\/radiocirugia_parkinson\/","title":{"rendered":"RADIOCIRUG\u00cdA FUNCIONAL EN LA ENFERMEDAD DE PARKINSON"},"content":{"rendered":"
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Por: Dr. Roberto Villag\u00f3mez Camargo
Ur\u00f3logo de CCT100
<\/em><\/span><\/figure>\n
Introducci\u00f3n<\/strong><\/span>
La enfermedad de Parkinson (EP) es un trastorno neurodegenerativo progresivo de aparici\u00f3n en la edad adulta y representa la segunda enfermedad neurodegenerativa m\u00e1s frecuente, seguida del Alzheimer. Se caracteriza por la p\u00e9rdida de neuronas dopamin\u00e9rgicas en la sustancia negra y la disfunci\u00f3n de los circuitos gangliobasales. Cl\u00ednicamente, se manifiesta con temblor, rigidez, bradicinesia y alteraciones posturales. Aunque el tratamiento farmacol\u00f3gico con levodopa y agonistas dopamin\u00e9rgicos constituye la base terap\u00e9utica, una proporci\u00f3n significativa de pacientes desarrolla refractariedad o efectos secundarios limitantes.<\/p>\n

 <\/p>\n

En este contexto, la cirug\u00eda funcional (como la estimulaci\u00f3n cerebral profunda) ha demostrado eficacia en el control del temblor y otros s\u00edntomas motores. Sin embargo, la necesidad de anestesia, el riesgo quir\u00fargico y las comorbilidades hacen que muchos pacientes no sean candidatos. La radiocirug\u00eda funcional representa una alternativa viable, precisa y ambulatoria, capaz de reproducir los efectos de una lesi\u00f3n quir\u00fargica mediante el uso de radiaci\u00f3n ionizante.<\/p>\n

\u00bfCu\u00e1l es el mecanismo de acci\u00f3n de la radiocirug\u00eda en la enfermedad de Parkinson?<\/strong>
La radiaci\u00f3n produce una secuencia de eventos biol\u00f3gicos que finalizan en una ablaci\u00f3n controlada del tejido neuronal. Inicialmente, se genera edema local y alteraci\u00f3n de la mielina; posteriormente, se produce gliosis y necrosis coagulativa, lo que interrumpe la transmisi\u00f3n an\u00f3mala en los circuitos motores. Este proceso puede tardar de 3 a 6 meses para manifestar el beneficio cl\u00ednico m\u00e1ximo<\/p>\n

\u00bfCu\u00e1les son las dianas terap\u00e9uticas en la enfermedad de Parkinson?<\/strong>
La elecci\u00f3n de la diana depende del s\u00edntoma predominante y de la fisiopatolog\u00eda implicada:
N\u00facleo ventral intermedio (VIM) del t\u00e1lamo: Principal blanco para el control del temblor. La talamotom\u00eda con radiocirug\u00eda produce disminuci\u00f3n del temblor en 70 a 90% de los casos.
Globo p\u00e1lido interno (GPi): Indicada en casos de diston\u00eda o discinesias inducidas por levodopa.
N\u00facleo subtal\u00e1mico (STN): Dianas emergentes, a\u00fan en evaluaci\u00f3n, con potencial de control global de s\u00edntomas motores.<\/p>\n

El volumen blanco suele ser esf\u00e9rico, de 3 a 5 mm de di\u00e1metro. La dosis prescrita var\u00eda entre 120 a 150 Gy al isocentro, y depende de la tolerancia de estructuras cercanas.<\/p>\n

Resultados cl\u00ednicos y seguridad
<\/span><\/strong>Diversos estudios internacionales han reportado resultados consistentes:
R\u00e9gis et al. (Marsella, 2019) observaron mejor\u00eda significativa del temblor en el 85% de los pacientes a 3 a\u00f1os.
Young et al. (Seattle, 2013) encontraron un control del temblor mayor al 80% con baja incidencia de complicaciones graves.<\/p>\n

Los efectos secundarios m\u00e1s frecuentes de la radiocirug\u00eda en enfermedad de Parkinson son: disartria transitoria, debilidad leve o parestesias, que generalmente son autolimitadas. Las complicaciones permanentes son poco frecuentes (<2%) cuando se respetan los m\u00e1rgenes de seguridad.<\/p>\n

Discusi\u00f3n<\/strong><\/span>
La radiocirug\u00eda funcional es una alternativa efectiva a la cirug\u00eda ablativa o estimulaci\u00f3n cerebral profunda, especialmente en pacientes mayores, con comorbilidades o con contraindicaci\u00f3n para procedimientos invasivos, ya que es segura, eficaz y m\u00ednimamente invasiva, capaz de ofrecer alivio sintom\u00e1tico en pacientes seleccionados.
Su principal fortaleza radica en la precisi\u00f3n anat\u00f3mica y seguridad, con una tasa m\u00ednima de complicaciones graves.<\/p>\n

Referencias:<\/span><\/strong><\/p>\n

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  • R\u00e9gis J, et al. Gamma Knife thalamotomy for tremor in Parkinson\u2019s disease: long-term results and predictive factors. J Neurosurg. 2019;131(2):507\u2013514.<\/li>\n
  • Young RF, et al. Stereotactic radiosurgery for movement disorders: current perspectives. Neurosurg Clin N Am. 2013;24(4):563\u2013573.<\/li>\n
  • Mart\u00ednez R, et al. Functional radiosurgery in Parkinsonian tremor: experience in Latin America. Radiother Oncol. 2021;159:124\u2013130.<\/li>\n
  • Kondziolka D, et al. Radiosurgical thalamotomy for essential tremor and Parkinsonian tremor: a review of outcomes. Neurology. 2020;94(5):e463\u2013e471.<\/li>\n
  • Lunsford LD, et al. Functional radiosurgery: current applications and future directions. Front Oncol. 2022;12:876345.<\/li>\n<\/ul>\n<\/figure>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"

    La enfermedad de Parkinson (EP) es un trastorno neurodegenerativo progresivo de aparici\u00f3n en la edad adulta y representa la segunda enfermedad neurodegenerativa m\u00e1s frecuente, seguida del Alzheimer. Se caracteriza por la p\u00e9rdida de neuronas dopamin\u00e9rgicas en la sustancia negra y la disfunci\u00f3n de los circuitos gangliobasales. Cl\u00ednicamente, se manifiesta con temblor, rigidez, bradicinesia y alteraciones posturales.<\/p>","protected":false},"author":1,"featured_media":20267,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[357],"tags":[423,391],"class_list":["post-20266","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-investigacion","tag-parkinson","tag-radiocirugia"],"yoast_head":"\nRADIOCIRUG\u00cdA FUNCIONAL EN LA ENFERMEDAD DE PARKINSON<\/title>\n<meta name=\"description\" content=\"La enfermedad de Parkinson (EP) es un trastorno neurodegenerativo progresivo de aparici\u00f3n en la edad adulta y representa la segunda enfermedad neurodegenerativa m\u00e1s frecuente, seguida del Alzheimer. Se caracteriza por la p\u00e9rdida de neuronas dopamin\u00e9rgicas en la sustancia negra y la disfunci\u00f3n de los circuitos gangliobasales. 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