1
|
Horisawa S, Kohara K, Nonaka T, Fukui A, Mochizuki T, Iijima M, Kawamata T, Taira T. Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia. Ann Clin Transl Neurol 2022; 9:478-487. [PMID: 35261204 PMCID: PMC8994978 DOI: 10.1002/acn3.51532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background Neurosurgical ablation of Forel's field H1 for cervical dystonia, which is currently abandoned, was formerly used in the 1960s–1970s. Regardless of the lack of neuroimaging modalities and objective evaluation scales, the reported efficacy was significant. Although recent studies have reappraised the ablation of the pallidothalamic tract at Forel's field H1 for Parkinson's disease, the efficacy for cervical dystonia has not been investigated well. Methods Data of 35 patients with cervical dystonia who underwent unilateral pallidothalamic tractotomy at Forel's field H1 were retrospectively analyzed. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores, the neck score of the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), and adverse events were evaluated preoperatively and at the last available follow‐up period. Results The mean clinical follow‐up period was 13.9 ± 6.5 months. The mean TWSTRS total scores were 34.3 ± 14.0 preoperatively and 18.4 ± 16.5 at the last available follow‐up period (46.4% improvement, p < 0.0001). The BFMDRS neck score also improved significantly from 6.2 ± 2.9 preoperatively to 2.8 ± 2.8 at the last available follow‐up period (55.0% improvement on the neck score, p < 0.0001). Reduced hand dexterity in seven patients, hypophonia in five patients, dysarthria in four patients, and executive dysfunction in one patient were confirmed as adverse events at the last available follow‐up evaluation. One patient had postoperative hemorrhage. Conclusion The current study confirmed significant improvement in TWSTRS total scores and BFMDRS neck scores at the 13.9‐month follow‐up after unilateral pallidothalamic tractotomy. The pallidothalamic tract in Forel's field H1 is expected to be an alternative treatment target for cervical dystonia.
Collapse
Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kotaro Kohara
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Taku Nonaka
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tatsuki Mochizuki
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Mutsumi Iijima
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
2
|
Horisawa S, Fukui A, Kohara K, Kawamata T, Taira T. Unilateral pallidotomy in the treatment of cervical dystonia: a retrospective observational study. J Neurosurg 2021; 134:216-222. [PMID: 31860811 DOI: 10.3171/2019.9.jns191202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to assess the efficacy of unilateral pallidotomy in patients with asymmetrical cervical dystonia. METHODS This study retrospectively included 25 consecutive patients with asymmetrical cervical dystonia refractory to botulinum toxin injections, who underwent unilateral pallidotomy between January 2015 and April 2017. Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were evaluated preoperatively and 1 week, 3 months, and 6 months postoperatively. The clinical responses were defined as good responders, exhibiting > 50% improvement in the TWSTRS score at 6 months postsurgery, or poor responders, exhibiting < 50% improvement in TWSTRS scores at 6 months postsurgery. RESULTS Twelve and 9 patients showed right- and left-side rotation, respectively; 1 and 3 patients had right- and left-side laterocollis, respectively. The mean age of onset and duration of the disease were 40.2 ± 13.9 and 8.9 ± 10.9 years, respectively. Mean TWSTRS scores were 38.4 ± 12.6 (p < 0.001), 17.3 ± 12.4 (p < 0.001), 19.5 ± 13.4 (p < 0.001), and 20.0 ± 14.7 (p < 0.001), preoperatively and 1 week, 3 months, and 6 months postoperatively, respectively. Fourteen patients (56%) demonstrated > 50% improvement in their TWSTRS total score (mean improvement of TWSTRS total score = 70.5%) 6 months postsurgically. Furthermore, preoperative TWSTRS severity score was a prognostic factor (odds ratio 1.37, 95% confidence interval 1.06-1.78, p = 0.003). CONCLUSIONS These results suggest that unilateral pallidotomy is an acceptable treatment option for asymmetrical cervical dystonia. Further investigations with a larger number of cases and longer follow-up period are required to confirm these data.
Collapse
|
3
|
Ishii N, Mochizuki H, Miyamoto M, Ebihara Y, Shiomi K, Nakazato M. 18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging evaluation of chorea. Neurol Int 2018; 10:7780. [PMID: 30344966 PMCID: PMC6176470 DOI: 10.4081/ni.2018.7780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/23/2018] [Indexed: 11/25/2022] Open
Abstract
Chorea is thought to be caused by deactivation of the indirect pathway in the basal ganglia circuit. However, few imaging studies have evaluated the basal ganglia circuit in actual patients with chorea. We investigated the lesions and mechanisms underlying chorea using brain magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). This retrospective case series included three patients with chorea caused by different diseases: hyperglycemic chorea, Huntington’s disease, and subarachnoid hemorrhage. All the patients showed dysfunction in the striatum detected by both MRI and FDG-PET. These neuroimaging findings confirm the theory that chorea is related to an impairment of the indirect pathway of basal ganglia circuit.
Collapse
Affiliation(s)
- Nobuyuki Ishii
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Hitoshi Mochizuki
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Miyuki Miyamoto
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Yuka Ebihara
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Kazutaka Shiomi
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Masamitsu Nakazato
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| |
Collapse
|
4
|
Johal J, Iwanaga J, Tubbs K, Loukas M, Oskouian RJ, Tubbs RS. The Accessory Nerve: A Comprehensive Review of its Anatomy, Development, Variations, Landmarks and Clinical Considerations. Anat Rec (Hoboken) 2018; 302:620-629. [DOI: 10.1002/ar.23823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/11/2017] [Accepted: 05/14/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Jaspreet Johal
- Department of Anatomical SciencesSt. George's UniversitySt. George's Grenada
- Seattle Science FoundationSeattle Washington
| | - Joe Iwanaga
- Seattle Science FoundationSeattle Washington
| | - Kevin Tubbs
- Seattle Science FoundationSeattle Washington
| | - Marios Loukas
- Department of Anatomical SciencesSt. George's UniversitySt. George's Grenada
| | | | - R. Shane Tubbs
- Department of Anatomical SciencesSt. George's UniversitySt. George's Grenada
- Seattle Science FoundationSeattle Washington
| |
Collapse
|
5
|
Abstract
The neural systems controlling head movements are not well delineated in humans. It is not clear whether the ipsilateral or contralateral primary motor cortex is involved in turning the head right or left. Furthermore, the exact location of the neck motor area in the somatotopic organization of the motor homunculus is still debated and evidence for contributions from other brain regions in humans is scarce. Because currently available neuroimaging methods are not generally suitable for mapping brain activation patterns during head movements, we conducted fMRI scans during isometric tasks of the head. During isometric tasks, muscle contractions occur without an actual movement and they have been used to delineate patterns of brain activity related to movements of other body parts such as the hands. Healthy individuals were scanned during isometric head rotation or wrist extension. Isometric wrist extension was examined as a positive control and to establish the relative locations of head and hand regions in the motor cortex. Electromyographic recordings of neck and hand muscles during scanning ensured compliance with the tasks. Increased brain activity during isometric head rotation was observed bilaterally in the precentral gyrus, both medial and lateral to the hand area, as well the supplementary motor area, insula, putamen, and cerebellum. These findings clarify the location of the neck region in the motor homunculus and help to reconcile some of the conflicting results obtained in earlier studies.
Collapse
|
6
|
Jin SW, Park KJ, Park DH, Kang SH. Intracisternal cranial root accessory nerve schwannoma associated with recurrent laryngeal neuropathy. J Korean Neurosurg Soc 2014; 56:152-6. [PMID: 25328655 PMCID: PMC4200365 DOI: 10.3340/jkns.2014.56.2.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/07/2014] [Accepted: 08/16/2014] [Indexed: 11/27/2022] Open
Abstract
Intracisternal accessory nerve schwannomas are very rare; only 18 cases have been reported in the literature. In the majority of cases, the tumor origin was the spinal root of the accessory nerve and the tumors usually presented with symptoms and signs of intracranial hypertension, cerebellar ataxia, and myelopathy. Here, we report a unique case of an intracisternal schwannoma arising from the cranial root of the accessory nerve in a 58-year-old woman. The patient presented with the atypical symptom of hoarseness associated with recurrent laryngeal neuropathy which is noted by needle electromyography, and mild hypesthesia on the left side of her body. The tumor was completely removed with sacrifice of the originating nerve rootlet, but no additional neurological deficits. In this report, we describe the anatomical basis for the patient's unusual clinical symptoms and discuss the feasibility and safety of sacrificing the cranial rootlet of the accessory nerve in an effort to achieve total tumor resection. To our knowledge, this is the first case of schwannoma originating from the cranial root of the accessory nerve that has been associated with the symptoms of recurrent laryngeal neuropathy.
Collapse
Affiliation(s)
- Sung-Won Jin
- Department of Neurosurgery, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea
| | - Kyung-Jae Park
- Department of Neurosurgery, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea
| | - Shin-Hyuk Kang
- Department of Neurosurgery, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea
| |
Collapse
|
7
|
Walsh RA, Sidiropoulos C, Lozano AM, Hodaie M, Poon YY, Fallis M, Moro E. Bilateral pallidal stimulation in cervical dystonia: blinded evidence of benefit beyond 5 years. Brain 2013; 136:761-9. [DOI: 10.1093/brain/awt009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
8
|
Tubbs RS, Benninger B, Loukas M, Cohen-Gadol AA. Cranial roots of the accessory nerve exist in the majority of adult humans. Clin Anat 2012; 27:102-7. [DOI: 10.1002/ca.22125] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/08/2012] [Accepted: 06/14/2012] [Indexed: 11/11/2022]
Affiliation(s)
- R. Shane Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama
| | - Brion Benninger
- Department of Medical Anatomical Sciences, Western University of Health Sciences, COMP-NW, Lebanon, Oregon
- Orthopedic Department, Samaritan Healthcare, Corvallis, Oregon
- General Surgery Department, Samaritan Healthcare, Corvallis, Oregon
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
- Orthopedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon. Oral Maxillofacial Surgery, Oregon Health & Science University, Portland, Oregon
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Aaron A. Cohen-Gadol
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
| |
Collapse
|
9
|
Kang SY, Ma HI, Lee MJ, Kwon SB, Jung S, Kim YJ, Hwang SH. Ipsilateral tilt and contralateral sensory change of neck in cortical infarction. J Clin Neurol 2011; 7:156-8. [PMID: 22087210 PMCID: PMC3212602 DOI: 10.3988/jcn.2011.7.3.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 03/16/2010] [Accepted: 03/16/2010] [Indexed: 11/17/2022] Open
Abstract
Background Numerous neck muscles are involved in neck movements, and so isolated neck weakness is extremely uncommon in cerebral infarction. Case Report We report herein the case of a 65-year-old woman with hypertension and acute cortical infarction, presenting with ipsilateral head tilt and contralateral sensory changes in the neck and shoulder area, which has never been described before. Conclusions Transient neck weakness and sensory deficits can occur in acute cortical infarction. The motor representation of the neck muscles can be at the same level of the cortical sensory representation, near to the level of the trunk representation, which is in contrast to Penfield's findings. Several possible mechanisms for the ipsilateral tilt are described.
Collapse
Affiliation(s)
- Suk Yun Kang
- Department of Neurology, Hallym University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
10
|
Transitional Nerve: A New and Original Classification of a Peripheral Nerve Supported by the Nature of the Accessory Nerve (CN XI). Neurol Res Int 2011; 2010:476018. [PMID: 21318044 PMCID: PMC3026986 DOI: 10.1155/2010/476018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 11/14/2010] [Indexed: 12/26/2022] Open
Abstract
Classically, the accessory nerve is described as having a cranial and a spinal root. Textbooks are inconsistent with regard to the modality of the spinal root of the accessory nerve. Some authors report the spinal root as general somatic efferent (GSE), while others list a special visceral efferent (SVE) modality. We investigated the comparative, anatomical, embryological, and molecular literature to determine which modality of the accessory nerve was accurate and why a discrepancy exists. We traced the origin of the incongruity to the writings of early comparative anatomists who believed the accessory nerve was either branchial or somatic depending on the origin of its target musculature. Both theories were supported entirely by empirical observations of anatomical and embryological dissections. We find ample evidence including very recent molecular experiments to show the cranial and spinal root are separate entities. Furthermore, we determined the modality of the spinal root is neither GSE or SVE, but a unique peripheral nerve with a distinct modality. We propose a new classification of the accessory nerve as a transitional nerve, which demonstrates characteristics of both spinal and cranial nerves.
Collapse
|
11
|
de Carvalho M, Pinto S, Swash M. Does the motor cortex influence denervation in ALS? EMG studies of muscles with both contralateral and bilateral corticospinal innervation. Clin Neurophysiol 2010; 122:629-635. [PMID: 20822953 DOI: 10.1016/j.clinph.2010.07.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 06/13/2010] [Accepted: 07/06/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the pattern of degeneration of lower motor neuron progression in ALS in relation to the contralateral and ipsilateral corticospinal innervation of the tested muscles. METHODS EMG evaluation of the sternomastoid and trapezius muscles on one or both sides, and transcranial magnetic stimulation to record motor evoked responses from these muscles after ipsilateral and contralateral cortical stimulation. The sternomastoid muscle receives corticospinal input from both hemispheres, but the trapezius only a contralateral corticospinal innervation; however the power motor innervation of both these muscles is derived from the same spinal nucleus, and the same motor nerve. Seventy-five patients with ALS were studied at the time of diagnosis, and 54 control subjects, consisting of normal subjects and disease control subjects. MUP analysis and spontaneous activity were assessed. RESULTS We confirmed that the sternomastoid receives both contralateral and ipsilateral corticospinal innervation, and the trapezius usually only contralateral innervation. The MUP analysis revealed symmetric changes in sternomastoid and trapezius muscles, and both muscles were equally affected. CONCLUSIONS Our findings are in accord with the concept that LMN degeneration in ALS is related to local factors in the spinal cord. SIGNIFICANCE Our findings suggest that local factors in the spinal grey matter are important in causing LMN degeneration in ALS, but they do not rule out a corticomotoneuronal contribution.
Collapse
Affiliation(s)
| | - Susana Pinto
- Institute of Molecular Medicine, Faculty of Medicine, Lisbon, Portugal
| | - Michael Swash
- Department of Neurosciences, St. Maria Hospital, Lisbon, Portugal; Department of Neurology, Royal London Hospital, Queen Mary School of Medicine, University of London, London, UK
| |
Collapse
|
12
|
Urban PP, Rolke R. Effects of botulinum toxin type A on vibration induced facilitation of motor evoked potentials in spasmodic torticollis. J Neurol Neurosurg Psychiatry 2004; 75:1541-6. [PMID: 15489383 PMCID: PMC1738799 DOI: 10.1136/jnnp.2003.029215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS It has not been clarified if botulinum toxin (BTX) injection leads to muscle spindle dysfunction in man. This study aimed to test the hypothesis that BTX application reduces the facilitation of a magnetic evoked response (MEP). METHODS We used the vibration induced facilitation of an MEP of the sternocleidomastoid muscle (SCM) as a surrogate marker for muscle spindle function in 20 healthy subjects and 10 patients with idiopathic rotational torticollis in whom BTX was injected unilaterally. RESULTS The increase in the amplitude and area of the MEPs in the clinically not affected and untreated SCM of the patients did not differ significantly from the controls. At baseline, the vibration induced increase in the affected SCM of the patients was significantly lower than in the control group. Six weeks after BTX application, the observed facilitation decreased significantly (amplitude and area: p<0.001) when compared with baseline values. Twelve weeks after BTX application, facilitation showed an increase in the values of the amplitude (p<0.001), but not of the area when compared with the six week examination. CONCLUSIONS We demonstrated that the vibration induced MEP facilitation in the SCM of patients with torticollis significantly decreased six weeks after BTX application and again increased after 12 weeks in part when looking at MEP amplitude. This observation is suggestive of denervation and reinnervation of the muscle spindles after BTX injection.
Collapse
Affiliation(s)
- P P Urban
- Department of Neurology, University of Mainz, Langenbeckstr. 1, D 55101, Germany.
| | | |
Collapse
|
13
|
Urban PP. Chapter 35 Transcranial magnetic stimulation in brainstem lesions and lesions of the cranial nerves. ACTA ACUST UNITED AC 2003; 56:341-57. [PMID: 14677411 DOI: 10.1016/s1567-424x(09)70238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Peter P Urban
- Department of Neurology, University of Mainz, Langenbeckstr. 1, D-55101 Mainz, Germany.
| |
Collapse
|
14
|
Escamilla-Sevilla F, Mínguez-Castellanos A, Arjona-Morón V, Martín-Linares JM, Sánchez-Alvarez JC, Ortega-Morenoa A, García-Gómez T. Unilateral pallidal stimulation for segmental cervical and truncal dystonia: which side? Mov Disord 2002; 17:1383-5. [PMID: 12465090 DOI: 10.1002/mds.10285] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We present a 24-year-old man with idiopathic segmental cervical and truncal dystonia of juvenile onset. His condition improved after unilateral stimulation of the internal globus pallidus ipsilateral to the contracting sternocleidomastoid muscle.
Collapse
|
15
|
Krauss JK, Loher TJ, Pohle T, Weber S, Taub E, Bärlocher CB, Burgunder JM. Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy. J Neurol Neurosurg Psychiatry 2002; 72:249-56. [PMID: 11796777 PMCID: PMC1737724 DOI: 10.1136/jnnp.72.2.249] [Citation(s) in RCA: 159] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Surgical treatment of complex cervical dystonia and of cervical dyskinesias associated with cervical myelopathy is challenging. In this prospective study, the long term effect of chronic pallidal stimulation in cervical dystonia and on combining the technique with spinal surgery in patients with severe cervical dyskinesias and secondary cervical myelopathy is described. METHODS Eight patients with a history of chronic dystonia who did not achieve adequate benefit from medical treatment or botulinum toxin injection participated in the study. Five patients had complex cervical dystonia with tonic postures and phasic movements. Three patients had rapidly progressive cervical myelopathy secondary to severe cervical dyskinesias and dystonia in the context of a generalised movement disorder. Quadripolar electrodes were implanted in the posteroventral lateral globus pallidus internus with stereotactic CT and microelectrode guidance. In the three patients with secondary cervical myelopathy, spinal surgery was performed within a few weeks and included multilevel laminectomies and a four level cervical corporectomy with spinal stabilisation. RESULTS Improvement of the movement disorder was noted early after pallidal surgery, but the full benefit could be appreciated only with a delay of several months during chronic stimulation. Three months after surgery, patients with cervical dystonia had improved by 38% in the severity score, by 54% in the disability score, and by 38% in the pain score of a modified version of the Toronto western spasmodic torticollis rating scale. At a mean follow up of 20 months, the severity score had improved by 63%, the disability score by 69%, and the pain score by 50% compared with preoperatively. There was also sustained amelioration of cervical dyskinesias in the three patients who underwent spinal surgery. Lead fractures occurred in two patients. The mean amplitude needed for chronic deep brain stimulation was 3.8 V at a mean pulse width of 210 micros, which is higher than that used for pallidal stimulation in Parkinson's disease. CONCLUSIONS Chronic pallidal stimulation is effective for complex cervical dystonia and it is a useful adjunct in patients with cervical dyskinesias and secondary cervical myelopathy who undergo spinal surgery.
Collapse
Affiliation(s)
- J K Krauss
- Department of Neurosurgery, University Hospital, Klinikum Mannheim, Mannheim, Germany.
| | | | | | | | | | | | | |
Collapse
|
16
|
Tanaka H, Arai M, Kubo J, Hirata K. Conjugate Eye Deviation With Head Version due to a Cortical Infarction of the Frontal Eye Field. Stroke 2002. [DOI: 10.1161/str.33.2.642] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hideaki Tanaka
- Department of Neurology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
| | - Mio Arai
- Department of Neurology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
| | - Jin Kubo
- Department of Neurology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
| |
Collapse
|
17
|
DeToledo JC, David NJ. Innervation of the sternocleidomastoid and trapezius muscles by the accessory nucleus. J Neuroophthalmol 2001; 21:214-6. [PMID: 11725190 DOI: 10.1097/00041327-200109000-00012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Images moving over the retina at velocities as low as a few degrees per second, in movements as head turning, can degrade visual acuity. Visual acuity requires that even minute motion of the head be compensated for, primarily via optokinetic and vestibular reflexes. Whereas we have a good understanding of some the neuronal networks involved in these reflexes, other components of this network, such as the innervation of the paired muscles that turn and tilt the head, are not as well understood. The involvement of the sternomastoid, cleidomastoid, or trapezius muscles with lesions of the cervicomedullary junction is often not in conformity with the prevailing neuroanatomic descriptions of their innervation by the accessory nuclei. We discuss evidence that: 1) the XI nucleus has a rostral and a caudal portion; 2) analogous to the VII nerve, the rostral portion receives projections from both cerebral hemispheres, whereas the caudal portion is innervated preferentially by the contralateral hemisphere; 3) the caudal XI nucleus innervates the ipsilateral cleidomastoid and trapezius with a predominantly crossed corticonuclear innervation; and 4) The rostral XI nucleus innervates both sternomastoids. Each rostral portion receives projections from both cerebral hemispheres. These anatomic features explain the seemingly discrepant findings in patients with cervicomedullary lesions.
Collapse
Affiliation(s)
- J C DeToledo
- Department of Neurology, University of Miami, Miami, Florida 33136, USA.
| | | |
Collapse
|
18
|
Parkin S, Aziz T, Gregory R, Bain P. Bilateral internal globus pallidus stimulation for the treatment of spasmodic torticollis. Mov Disord 2001; 16:489-93. [PMID: 11391743 DOI: 10.1002/mds.1092] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Three patients with spasmodic torticollis (ST) obtained substantial benefit from bilateral globus pallidus internus (GPi) stimulation. Progressive improvement in ST occurred over several months but residual cervical dystonia remained. These results corroborate those obtained by Krauss et al. on three patients with ST.
Collapse
Affiliation(s)
- S Parkin
- Department of Neurosciences, Radcliffe Infirmary, Oxford, United Kingdom
| | | | | | | |
Collapse
|