Neuromodulation of the posterolateral hypothalamus for the treatment of chronic refractory cluster headache: Experience in five patients with a modified anatomical target

INTRODUCTION

Deep brain stimulation (DBS) of the posterior hypothalamus has been found to be effective in the treatment of refractory chronic cluster headache (CCH).

METHODS

We report the long-term outcomes of five patients with refractory CCH on whom stimulation of a modified target of approximately 3 mm in radius, which included the posterolateral hypothalamus, the fasciculus mammillotegmentalis, the fasciculus mammillothalamicus and the fasciculus medialis telencephali, was performed. The stereotaxic coordinates were 4 mm from the third ventricle wall, 2 mm from behind the mid-intercommissural point and 5 mm from under the intercommissural line.

RESULTS

All patients became pain-free for 1-2 weeks after the procedure, but then needed an average of 54 days to optimize stimulation parameters. After a mean follow-up of 33 months, two remain pain-free, two have an excellent response (>90% decrease in attack frequency) and in one the attacks have been reduced by half. There were no serious adverse events. Permanent myosis and euphoria/well-being feeling were seen in three patients. Other adverse events, such as diplopia, dizziness, global headache of cervical dystonia, were seen transiently related to an increase in stimulation parameters. Attacks reappeared transiently in two patients as a result of cable rupture and when the stimulator was disconnected.

CONCLUSIONS

Our results supports the efficacy of DBS in very refractory CCH with a slightly modified hypothalamic target conceived to avoid the lateral ventricle wall so as to extend the stimulated brain area and to decrease the morbidity of potential haemorrhagic complications.

Effect of land uses and wind direction on the contribution of local sources to airborne pollen

The interpretation of airborne pollen levels in cities based on the contribution of the surrounding flora and vegetation is a useful tool to estimate airborne allergen concentrations and, consequently, to determine the allergy risk for local residents. This study examined the pollen spectrum in a city in central Spain (Guadalajara) and analysed the vegetation landscape and land uses within a radius of 20km in an attempt to identify and locate the origin of airborne pollen and to determine the effect of meteorological variables on pollen emission and dispersal. The results showed that local wind direction was largely responsible for changes in the concentrations of different airborne pollen types. The land uses contributing most to airborne pollen counts were urban green spaces, though only 0.1% of the total surface area studied, and broadleaved forest which covered 5% of the study area. These two types of land use together accounted for 70% of the airborne pollen. Crops, scrubland and pastureland, though covering 80% of the total surface area, contributed only 18.6% to the total pollen count, and this contribution mainly consisted of pollen from Olea and herbaceous plants, including Poaceae, Urticaceae and Chenopodiaceae-Amaranthaceae. Pollen from ornamental species were mainly associated with easterly (Platanus), southerly (Cupressaceae) and westerly (Cupressaceae and Platanus) winds from the areas where the city's largest parks and gardens are located. Quercus pollen was mostly transported by winds blowing in from holm-oak stands on the eastern edge of the city. The highest Populus pollen counts were associated with easterly and westerly winds blowing in from areas containing rivers and streams. The airborne pollen counts generally rose with increasing temperature, solar radiation and hours of sunlight, all of which favour pollen release. In contrast, pollen counts declined with increased relative humidity and rainfall, which hinder airborne pollen transport.

The mossy north: an inverse latitudinal diversity gradient in European bryophytes

It remains hotly debated whether latitudinal diversity gradients are common across taxonomic groups and whether a single mechanism can explain such gradients. Investigating species richness (SR) patterns of European land plants, we determine whether SR increases with decreasing latitude, as predicted by theory, and whether the assembly mechanisms differ among taxonomic groups. SR increases towards the south in spermatophytes, but towards the north in ferns and bryophytes. SR patterns in spermatophytes are consistent with their patterns of beta diversity, with high levels of nestedness and turnover in the north and in the south, respectively, indicating species exclusion towards the north and increased opportunities for speciation in the south. Liverworts exhibit the highest levels of nestedness, suggesting that they represent the most sensitive group to the impact of past climate change. Nevertheless, although the extent of liverwort species turnover in the south is substantially and significantly lower than in spermatophytes, liverworts share with the latter a higher nestedness in the north and a higher turn-over in the south, in contrast to mosses and ferns. The extent to which the similarity in the patterns displayed by spermatophytes and liverworts reflects a similar assembly mechanism remains, however, to be demonstrated.

Modeling pollen time series using seasonal-trend decomposition procedure based on LOESS smoothing

Analysis of airborne pollen concentrations provides valuable information on plant phenology and is thus a useful tool in agriculture-for predicting harvests in crops such as the olive and for deciding when to apply phytosanitary treatments-as well as in medicine and the environmental sciences. Variations in airborne pollen concentrations, moreover, are indicators of changing plant life cycles. By modeling pollen time series, we can not only identify the variables influencing pollen levels but also predict future pollen concentrations. In this study, airborne pollen time series were modeled using a seasonal-trend decomposition procedure based on LOcally wEighted Scatterplot Smoothing (LOESS) smoothing (STL). The data series-daily Poaceae pollen concentrations over the period 2006-2014-was broken up into seasonal and residual (stochastic) components. The seasonal component was compared with data on Poaceae flowering phenology obtained by field sampling. Residuals were fitted to a model generated from daily temperature and rainfall values, and daily pollen concentrations, using partial least squares regression (PLSR). This method was then applied to predict daily pollen concentrations for 2014 (independent validation data) using results for the seasonal component of the time series and estimates of the residual component for the period 2006-2013. Correlation between predicted and observed values was r = 0.79 (correlation coefficient) for the pre-peak period (i.e., the period prior to the peak pollen concentration) and r = 0.63 for the post-peak period. Separate analysis of each of the components of the pollen data series enables the sources of variability to be identified more accurately than by analysis of the original non-decomposed data series, and for this reason, this procedure has proved to be a suitable technique for analyzing the main environmental factors influencing airborne pollen concentrations.

Plant diversity partitioning in Mediterranean croplands: effects of farming intensity, field edge, and landscape context

Farmland biodiversity is affected by factors acting at various spatial scales. However, most studies to date have focused on the field or farm scales that only account for local (alpha) diversity, and these may underestimate the contribution of other diversity components (beta diversity) to total (gamma) farmland diversity. In this work, we aimed to identify the most suitable management options and the scale at which they should be implemented to maximize benefits for diversity. We used a multi-scale additive partitioning approach, with data on plant diversity from 640 plots in 32 cereal crop fields from three agricultural regions of central Spain that differed in landscape configuration. We analyzed the relative contribution to overall plant diversity of different diversity components at various spatial scales and how these diversity components responded to a set of local (application of agri-environment schemes [AES] and position within the field) and landscape (field size and landscape connectivity and composition) factors. Differences in species composition among regions and then among fields within regions contributed most to overall plant diversity. Positive edge effects were found on all diversity components at both the field- and regional scales, whereas application of AES benefited all diversity components only at the field scale. Landscape factors had strong influences on plant diversity, especially length of seminatural boundaries, which increased species richness at both the field and the regional scales. In addition, positive effects of percentage of nonproductive land-uses in the landscape were found on all diversity components at the regional scale. Results showed that components that contributed most to overall plant diversity were not benefited by current AES. We conclude that agri-environmental policies should incorporate and prioritize measures aimed at the maintenance of seminatural boundaries and patches of nonproductive habitats within agricultural landscapes, through landscape planning, cross-compliance, or high nature-value farmland programs. These options will help to conserve overall plant diversity at regional scales, as well as the spillover of plant species from such seminatural elements into crops, especially in Mediterranean areas that still harbor extensive farming and relatively complex landscapes.

Standardised index for measuring atmospheric grass-pollen emission

Grass pollen is the main cause of pollen allergy in Europe, and-given its marked allergenic potential and elevated airborne concentrations-constitutes a major public health risk. This study sought to identify the grass species triggering allergies during the highest-risk periods, and to measure the contribution of each species to airborne grass pollen concentrations. This type of research is particularly useful with a view to optimising the prevention and diagnosis of pollen allergies and developing the most effective immunological treatments. To that end, a total of 28 species potentially responsible for allergies were analysed. In order to assess the potential contribution of these species to overall airborne pollen concentrations, an index was designed (Pollen Contribution Index) based on the following parameters for each species: flowering phenology, pollen grain size (polar and equatorial axes), abundance of the species in the area and pollen production. The species contributing most to airborne pollen concentrations were, in order: Dactylis glomerata subsp. hispanica, Lolium rigidum, Trisetum paniceum and Arrhenatherum album. These species all shared certain features: small grain size (and thus greater buoyancy in air), high pollen production and considerable abundance. This Index was applied to a case study in a Mediterranean-climate area of the central Iberian Peninsula, but could equally be applied to other areas and other allergenic pollens. Findings showed that a small number of species were responsible for most airborne grass pollen.

Characterisation of the airborne pollen spectrum in Guadalajara (central Spain) and estimation of the potential allergy risk

Aerobiological research into airborne pollen diversity and seasonal variations in pollen counts has become increasingly important over recent decades due to the growing incidence of asthma, rhinitis and other pollen-related allergic conditions. Airborne pollen in Guadalajara (Castilla-La Mancha, Spain) was studied over a 6-year period (2008-2013) using a Hirst-type volumetric spore trap. The highest pollen concentrations were recorded from February to June, coinciding with the pollen season of the pollen types that most contribute to the local airborne pollen spectrum: Cupressaceae (32.2%), Quercus (15.1%), Platanus (13.2%), Olea (8.3%), Populus (7.8%) and Poaceae (7.2%). These are therefore critical months for allergy sufferers. The pollen calendar was typically Mediterranean and comprised 25 pollen types. Between January and March, Cupressaceae pollen concentrations exceeded allergy risk thresholds on 38 days. Other woody species such as Olea and Platanus have a shorter pollen season, and airborne concentrations exceeded allergy risk thresholds on around 13 days in each case. Poaceae pollen concentrations attained allergy risk levels on 26 days between May and July. Other highly allergenic pollen types included Urticaceae and Chenopodiaceae-Amaranthaceae, though these are less abundant than other pollen types in Guadalajara and did not exceed risk thresholds on more than 3 and 5 days, respectively.

Models for forecasting airborne Cupressaceae pollen levels in central Spain

The influence of meteorological variables on airborne Cupressaceae pollen levels in central Spain was analyzed, and prediction models based on polynomial and multiple regressions were used to predict pollen counts throughout the pollen season. The Cupressaceae pollen type was selected in view of both its abundance in the atmosphere of the central Iberian Peninsula (particularly from January to March) and its allergenic importance. Sampling was performed uninterruptedly over a 5-year period, using a Hirst volumetric sampler and the sampling method established by the Spanish Aerobiology Network. Temperature displayed the strongest (positive) correlation with Cupressaceae pollen counts. Polynomial and multiple regression analysis showed that maximum temperature was the most influential variable included in prediction models. The prediction equations obtained for the study period were reasonably satisfactory, accounting for 48% and 59% of the variation in airborne pollen levels.

Causes of increased pollen exposure during Saharan-Sahel dust intrusions

Airborne particulate matter such as mineral dust comes mainly from natural sources, and the African regions of Sahara and Sahel originate large amounts of the aerosols dispersed worldwide. There is little knowledge about the influence of dust episodes on airborne pollen concentrations, and although the centre and southeast of the Iberian Peninsula are frequently affected by dust intrusions, until now, no specific works have analysed the effect of these episodes on airborne pollen concentrations in these areas. The aims of this study were to analyse the simultaneous occurrence of airborne pollen peaks and Saharan-Sahel dust intrusions in the central and south-eastern Iberian Peninsula, and to study the weather conditions - air mass pathways and conditions of air temperature, relative humidity and atmospheric pressure - that influence the airborne pollen concentrations during dust episodes. The results showed that the rise in airborne pollen concentrations during dust episodes is apparent in inland Iberian areas, although not in coastal areas in the southeast where pollen concentrations are even observed to decrease, coinciding with prevailing easterly winds from the sea. Total pollen concentrations and specific pollen types such as Olea, Poaceae and Quercus showed an increase in the central Iberian Peninsula during dust episodes when two meteorological phenomena concur: 1) prevailing winds from extensive areas of major wind-pollinated pollen sources over a medium or short distance (mainly from western and southwestern areas); and 2) optimal meteorological conditions that favour pollen release and dispersal into the atmosphere (mainly high temperatures and subsequently low humidity in central areas). Both conditions often occur during the Saharan-Sahel dust intrusions in the centre. Maximum pollen peaks are therefore most likely to occur during dust episodes in the central Iberian Peninsula, thus dramatically increasing the risk of outbreaks of pollinosis and other respiratory diseases in the population.

Histopathological findings in oral lichen planus and their correlation with the clinical manifestations

OBJECTIVES

To highlight the most characteristic histopathological findings of oral lichen planus and their correlation with the clinical manifestations and forms.

STUDY DESIGN

We performed a retrospective study of 50 biopsied and diagnosed cases of oral lichen planus obtained over a period of 11 years, spanning from May 1998 to April 2009. We analyzed the age and sex of the patient, type of lichen planus, location and different histopathological findings, comparing them with the clinical lesions.

RESULTS

Seventy eight percent of the patients are female and 22% are male, with an average age of 56.06 years for both sexes. The most frequent clinical form is reticular, present in 78% of the cases, and the most common location is the buccal mucosa, present in 70% of the patients. Hydropic degeneration of the basal layer and lymphocytic infiltration in the subepithelial layer are observed in the entire sample. Signs of atypia were identified in 4% of the cases, but without dysplasic features. Other common histological findings were the presence of necrotic keratinocytes (92%), hyperplasia (54%), hyperkeratosis (66%), acanthosis (48%), and less frequently, serrated ridges (30%) and the presence plasma cells (26%).

CONCLUSIONS

Oral lichen planus is a disease that is more common in women, usually appearing in the fifth and sixth decades of life. The most common clinical form is reticular, manifesting mainly in the buccal mucosa. Histological findings characteristic of oral lichen planus include hydropic degeneration of the basal layer, lymphocytic infiltration in the subepithelial layer and the absence of epithelial dysplasia; however, it is also frequent to observe hyperplasia phenomena at the epithelial level, hyperkeratosis, acanthosis and the presence of necrotic keratinocytes.

[A proposed new target for deep brain stimulation in obsessive-compulsive disorder]

INTRODUCTION

The obsessive-compulsive disorder (OCD) has an incidence in general population of 1.5-3%. If we consider as a positive respond a diminution of the 25-35% in the symptoms of OCD according to the Y-BOCS, and we add the cognitive-behavioral therapy to the pharmacological treatment, only a 40-60% of treated patients would have significant improvement and a 10% of patients with OCD, would be refractory to all type of medical treatment.

DEVELOPMENT

Current neurosurgical techniques for resistant cases of OCD interrupt the connections between the frontal lobes and subcortical structures (cingulotomy, capsulotomy). These techniques are ablative and irreversible. It shows the importance of finding a less aggressive technique with better clinical results. Deep brain stimulation (DBS) is an alternative to traditional neurosurgery based in neuromodulation methods. It's considered that the physiopathology of the OCD consists of a dysfunction of the direct and indirect vias that control the extrapiramidal limbic circuit. On the other hand, it had been obtained positive results after DBS of the subthalamic nucleus of three patients with Parkinson's disease and OCD.

CONCLUSION

This article has as target the demonstration that bilateral DBS of the limbic part of the subthalamic nucleus is an alternative for the treatment of refractory OCD.

[The physiopathology and management of sexual dysfunction in epileptic patients]

AIM

To review sexual dysfunction in epileptic patients, which is an aspect of the disease that is often deemed as being of little importance, but which exerts a decisive influence on the quality of life of these patients.

DEVELOPMENT

The alterations in sexual functioning in epilepsy have a complex physiopathology, can be of different types and occur during seizures, the aura or in the intercritical periods. Their clinical expression depends on the sex and age of the patient. The severity and incidence of sexual dysfunction are influenced by the treatment being used, the psychosocial adjustment of the individual, and certain aspects of epilepsy such as the age at onset, time to progression, location of the focus, the type of seizures and the degree of control the patient has over them. The therapeutic strategy is based on adjusting or modifying the antiepileptic therapy and then treating the sexual dysfunction and/or possible hormonal upsets.

CONCLUSIONS

Sexuality is a fundamental human right and as a health provider, the physician must take this aspect of the disease into account when dealing with epileptic patients by attempting to detect and characterise the disorder. The patient must be informed of the possible effects of epilepsy and its treatment on sexual functioning, and also the therapeutic options the physician considers to be best suited to the patient's particular case. He or she should also be encouraged to play an active role in making decisions on the matter and it is necessary to carry out developmental monitoring that takes into account the impact that improved sexual functioning is going to have on the patient's psychosocial and family adjustment.

[Stereotactic target identification for neurosurgery of Parkinson disease]

INTRODUCTION

The use of applied neurophysiological methods to improve the stereotactic localization of devices in the deep human brain is a high and systematic technology in Parkinson's neurosurgery today. The available standard equipment for clinical neurophysiology practice may constitute the basic set for high tech functional neurosurgery. Free run and event related multiunit recording, naturalistic and electrical evoked potentials, and deep brain microstimulation responses are the basic methodological set to neurophysiological target localization.

DEVELOPMENT AND CONCLUSIONS

This article is concerned with the topic: set out a high technology using low cost equipment. So our 41 cases experienced in pallidal and thalamic nucleolisis and thalamus and subthalamus DBS results suggest that the proposed equipment and methods are the required to assure accuracy and safety for target location.

Increased rupture of cypress pollen type due to atmospheric water in central and southeastern Spain

This study aims to investigate the meteorological variables determining Cupressaceae pollen grain disruption in the environment. A parallel sampling of pollen grains and disrupted Cupressaceae pollen grains was performed in six cities using two Spanish aerobiological networks. The pollen concentrations, disrupted pollen concentrations, percentage of disrupted pollen and number of days when the percentage of disrupted pollen was above or equal to 50 % were quantified during two pollen seasons. The concentrations were determined following the standardised method EN 16868. Results show that the concentrations of pollen grains and disrupted pollen grains were not determined by geographical features and rarely by bioclimatic variables or indexes but by the ornamental use of the specimens in the vicinity of the pollen sampler, highlighting the possibility of using management practices to reduce exposure to allergens in the cities. African dust outbreaks coincided with higher concentrations of pollen grains and disrupted pollen grains, but the reduced percentage of disrupted pollen grains pointed to a non-causal relationship with long-distance transport. The effect of wind and maximum gusts remained negligible. The triggering factor for pollen disruption was the amount of water in the atmosphere, mainly reported as relative humidity. Rainfall increased the effect of disruption due to pollen grain swelling caused by its wash-out effect. The higher the relative humidity, the higher the disrupted pollen concentrations. This aligns with the mechanism of Cupressaceae reproduction since the family needs a water medium in the form of pollination droplets for the pollination tube to develop and the pollen grain to perform its biological function. Therefore, people that develop allergic symptoms to Cupresaceae pollen should avoid exposure during days with high relative humidity in the main pollen season.

Aerobiological study in east-central Iberian Peninsula: pollen diversity and dynamics for major taxa

A study was made of airborne pollen counts in Cuenca (east-central Iberian Peninsula, Spain), using data obtained over a 3-year period (2008-2010). This is the first such study carried out in the World Heritage city of Cuenca, situated in the large region of Castilla-La Mancha. Air monitoring was performed using the sampling and analysis procedures recommended by the Spanish Aerobiology Network. Sampling commenced in mid- 2007, and provided the first recorded pollen-spectrum for the area. The greatest pollen-type diversity was recorded in spring, whilst the highest pollen counts (over 80 percent of the annual total) were observed between February and June. The lowest counts were found in September, November and December. The 10 leading taxa, in order of abundance, were: Cupressaceae, Quercus, Urticaceae, Pinus, Olea, Poaceae, Populus, Platanus, Chenopodiaceae-Amaranthaceae and Plantago. The pollen calendar was thus typically Mediterrean, and comprised the 27 pollen types reaching 10-day mean counts of over 1 grain/m(3) of air. Maximum concentration values during the day were recorded between 12:00-20:00, coinciding with the highest temperatures and lowest humidity levels. The pollen types responsible for most allergies in the city of Cuenca, ordered by the number of days on which risk levels were reached, were: Poaceae, Urticaceae, Cupressaceae, Olea, Platanus and Chenopodiaceae-Amaranthaceae.

[Neurophysiological monitoring in the treatment of pain]

INTRODUCTION

The concept of transynaptic deafferentation secondary to a lesion is the basis of the therapeutic criteria of functional neurosurgery.

DEVELOPMENT

Pain due to deafferentation requires clinical neurophysiological techniques for characterization, and when appropriate, for localization of the level of the lesion and the ectopic focus or foci which cause the pain syndrome. However, monitoring therapeutic interventions in the pain clinic is an ever increasing need, and obliges the clinical neurophysiologist to master the range of techniques involved in his specialty, so that he can use the most suitable techniques and methods as required by each condition and/or case. The use of techniques such as micro-recordings of the unitary or multiunitary activity of the nerves or nuclei, intracerebral evoked potentials, nociceptive evoked potentials, reflexology, polysomnography and topography, together with techniques such as percutaneous objective localization of deep nerves, allows quantitative evaluation pre-, intra- and postoperative.

CONCLUSION

The development of neuromodulation, and in particular of acute or long-term neurostimulation by use of percutaneous techniques, offers an effective therapeutic option in the field of clinical neurophysiology.

[Nerve compression syndrome in the thoracic outlet]

INTRODUCTION

The nerve conduction studies, F-waves and dermatosomal and lor somatosensory evoked potential have a low level of sensitivity for Thoracic Outlet Compression Syndrome (TOCS) diagnosis. A standard negative electrodiagnostic study does not exclude the presence of TOCS.

OBJECTIVE

The purpose of this neurophysiological note is that the Wright's hyperabduction, costoclavicular compression and Adson's scalenus tests important in making a clinical diagnosis of TOCS can be used as neurophysiological provocative maneuvers to determine the effect of braquial position on electrodiagnostic parameters.

MATERIAL AND METHODS

Nine selected TOCS patients were evaluated previous and following provocative maneuvers for 3 and 6 minutes.

RESULTS

The results showed a positive electrodiagnostic study in 7/9 patients.

CONCLUSIONS

It is suggested that patients with presumptive TOCS and negative electrodiagnostic findings be reevaluated immediately after 6 minutes of Wright's, Adson's or costoclavicular compression provocative tests.

Desert dust intrusions and their incidence on airborne biological content. Review and case study in the Iberian Peninsula

Desert dust intrusions cause the transport of airborne particulate matter from natural sources, with important consequences for climate regulation, biodiversity, ecosystem functioning and dynamics, human health, and socio-economic activities. Some effects of desert intrusions are reinforced or aggravated by the bioaerosol content of the air during these episodes. The influence of desert intrusions on airborne bioaerosol content has been very little studied from a scientific point of view. In this study, a systematic review of scientific literature during 1970-2021 was carried out following the standard protocol Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). After this literature review, only 6% of the articles on airborne transport from desert areas published in the last 50 years are in some way associated with airborne pollen, and of these, only a small proportion focus on the study of pollen-related parameters. The Iberian Peninsula is affected by Saharan intrusions due to its proximity to the African continent and is seeing an increasing trend the number of intrusion events. There is a close relationship among the conditions favouring the occurrence of intrusion episodes, the transport of particulate matter, and the transport of bioaerosols such as pollen grains, spores, or bacteria. The lack of linearity in this relationship and the different seasonal patterns in the occurrence of intrusion events and the pollen season of most plants hinders the study of the correspondence between both phenomena. It is therefore important to analyse the proportion of pollen that comes from regional sources and the proportion that travels over long distances, and the atmospheric conditions that cause greater pollen emission during dust episodes. Current advances in aerobiological techniques make it possible to identify bioaerosols such as pollen and spores that serve as indicators of long-distance transport from remote areas belonging to other bioclimatic and biogeographical units. A greater incidence of desert intrusion episodes may pose a challenge for both traditional systems and for the calibration and correct validation of automatic aerobiological monitoring methods.

[Psychiatric symptoms of Parkinson's disease following deep brain stimulation surgery on the subthalamic nucleus]

AIM

To review the increasing number of papers that report diverse neuropsychiatric disorders that happen in patients diagnosed of Parkinson's disease submitted to brain deep stimulation of subthalamic nuclei with high frequency current.

DEVELOPMENT

It is a fact the need to evaluate carefully all the patients who have to submit to this surgical procedure analyzing previous psychiatric history, and the possible appearance of psychiatric sphere symptoms after surgery. The acute depression and the euphoric moods (than can occur immediately after surgery) and major depression, obsession, widespread anxiety and substance abuse (among those of more delayed appearance) constitute examples of this pathology. The treatment of previous psychiatric disorders is forced in all cases and specially relevant in the major depression when suicide ideas coexist.

CONCLUSIONS

Information that allow to predict the risk of developing depressive disorders in the postoperative period does not exist at present time, though it is more predictable that it happens in those patients with previous severe depressive history. In general, euphoric moods, apathy and depression, usually are transient and of multifactorial origin that includes the existence of endogenous predisposition, the change to an independence pattern after surgery, the psychotropic effect of levodopa, and the high frequency current stimulation effect on the non motor structures target and in the adjacent regions. It must be outlined that it is possible the appearance of psychotic symptoms after brain deep stimulation of subthalamic nuclei in patients with ideal results on motor disability.