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Li J, Mei S, Zhang X, Wang Y, Jia X, Liu J, Xu E, Mao W, Zhang Y. Case report: Combined therapy of bilateral subthalamic nucleus deep brain stimulation and spinal cord stimulation significantly improves motor function in a patient with multiple system atrophy with predominant parkinsonism. Front Neurosci 2022; 16:929273. [PMID: 35979336 PMCID: PMC9376352 DOI: 10.3389/fnins.2022.929273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple system atrophy with predominant parkinsonism (MSA-P) is a highly incapacitating disease with a short life expectancy and symptomatic therapy is still limited. In this report, we presented the case of a 65-year-old woman with a 3-year history of severe rigidity, bradykinesia, and gait dysfunction alongside severe freezing of gait diagnosed with MSA-P. She underwent combined therapy of bilateral subthalamic nucleus deep brain stimulation (DBS) and low-thoracic spinal cord stimulation (SCS). The double-blind evaluation of the Movement Disorder Society Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III and 7-m Timed Up and Go at follow-ups showed her cardinal parkinsonian symptoms benefit significantly from DBS stimulation, while the improvement of SCS was mainly embodied in lower-limb symptoms. The combined stimulation achieved a better improvement of motor function than either DBS or SCS stimulation alone. Most notably, the improvement of lower-limb symptoms was significantly enhanced by the combined stimulation.
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Affiliation(s)
- Jiping Li
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shanshan Mei
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaohua Zhang
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yunpeng Wang
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaofei Jia
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinlong Liu
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Erhe Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Mao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuqing Zhang
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Wang Y, Li P, Gong F, Gao Y, Xu YY, Wang W. Micro lesion effect of the globus pallidus internus with deep brain stimulation in Parkinson's disease patients. Acta Neurochir (Wien) 2017; 159:1727-1731. [PMID: 28755172 DOI: 10.1007/s00701-017-3271-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The micro-lesion effect (MLE) has been observed in many Parkinson's disease (PD) patients after deep brain stimulation (DBS) surgery. For subthalamic nucleus (STN) stimulation, the MLE has been reported as a predictor of the long-term efficacy of DBS. However, the research on the MLE in the globus pallidus internus (GPi) is insufficient. In this report, we conducted a study of the correlation between the MLE and improvement of GPi DBS. METHODS From July 2014 to November 2015, 36 PD patients underwent GPi DBS in our hospital. The patients were evaluated before DBS and postoperatively at 24 h, 1 week, 2 weeks, 3 weeks, 6 months and 1 year. The evaluated items included the following: the UPDRSIII score with and without medication, off time per day and severe dyskinesia time per day. The dose of L-dopa, magnitude and duration of MLE were also recorded. RESULTS There were 32 patients with a postoperative MLE. In these 32 cases, the dose of L-dopa decreased from 960.5 ± 257.8 mg (range, 550-1550) to 910.4 ± 207.5 mg (range, 550-1250). There is a correlation between the magnitude of the MLE in UPDRSIII and the improvement degree of DBS at 6 and 12 months compared with the preoperative findings when off medication. The duration of the MLE is also an indication of the improvement of DBS in the long term when off medication. However, there was no correlation with on medication. Compared with the preoperative state, the UPDRSIII score, off time and severe dyskinesia time had improved postoperatively. CONCLUSIONS The MLE of GPi is a predictor of PD patients who would benefit from DBS in the long term. Medication may have some conflicting effects on the MLE. The exact mechanism of the MLE requires further exploration.
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Affiliation(s)
- Yi Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, China
| | - Peng Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, China
| | - FeiLong Gong
- Department of Neurosurgery, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, China
| | - Yuan Gao
- Department of Neurosurgery, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, China
| | - Yang Y Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, China.
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Faggiani E, Benazzouz A. Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: From history to the interaction with the monoaminergic systems. Prog Neurobiol 2017; 151:139-156. [DOI: 10.1016/j.pneurobio.2016.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 07/08/2016] [Indexed: 11/16/2022]
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Outcome of deep brain stimulation in slowly progressive multiple system atrophy: A clinico-pathological series and review of the literature. Parkinsonism Relat Disord 2016; 24:69-75. [DOI: 10.1016/j.parkreldis.2016.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/18/2015] [Accepted: 01/06/2016] [Indexed: 11/22/2022]
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Kronenbuerger M, Nolte KW, Coenen VA, Burgunder JM, Krauss JK, Weis J. Brain alterations with deep brain stimulation: New insight from a neuropathological case series. Mov Disord 2015; 30:1125-30. [PMID: 26011773 DOI: 10.1002/mds.26247] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 03/20/2015] [Accepted: 03/26/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Previous studies on human brain tissue alterations caused by deep brain stimulation described glial and reactive inflammatory changes. In the current pathoanatomical study, we extended the analysis to signs of axonal changes and the influence of concomitant disease. METHODS Brains of 10 patients with Parkinson's disease or essential tremor and a total of 18 electrodes were systematically examined up to 7.5 y after surgery. RESULTS In general, tissue that had long-term contact with the electrode material exhibited astrogliosis in all, T-lymphocytes in 93%, and multinucleated giant cells in 68% of patients. Immunohistochemistry showed an increase in amyloid precursor protein immunoreactive axonal swellings in the brain at the electrically active parts of the electrodes. Patients who died of septicemia showed a more severe astrogliosis and giant cell reaction than patients who died of cardiovascular events. Parkinson's disease or essential tremor did not differentially produce histopathological changes around the electrodes. CONCLUSION Long-term electrical stimulation by deep brain stimulation causes minor axonal changes. The cause of death, but not the underlying neurological disease, affects the histopathological changes around the electrode. The findings need to be reproduced by examining larger patient subgroups.
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Affiliation(s)
- Martin Kronenbuerger
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
| | - Kay Wilhelm Nolte
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany
| | - Jean-Marc Burgunder
- Department of Neurology, University of Berne, Inselspital, Berne, Switzerland
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover (MHH), Hannover, Germany
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
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Thavanesan N, Gillies M, Farrell M, Green AL, Aziz T. Deep brain stimulation in multiple system atrophy mimicking idiopathic Parkinson's disease. Case Rep Neurol 2014; 6:232-7. [PMID: 25473395 PMCID: PMC4250004 DOI: 10.1159/000368571] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Deep brain stimulation (DBS) is approved for idiopathic Parkinson's disease (IPD) but has a poor evidence base in Parkinson-plus syndromes such as multiple system atrophy (MSA). We describe the clinical and neuropathological findings in a man who was initially diagnosed with IPD, in whom DBS was unsuccessful, and in whom MSA was unexpectedly diagnosed at a subsequent autopsy. This case report highlights that DBS is often unsuccessful in MSA and also demonstrates that MSA can masquerade as IPD, which may explain treatment failure in a small group of patients apparently suffering from Parkinson's disease. Additionally, it also presents a case with an unusually long duration of disease prior to death, comparable only to a handful of other cases in the literature.
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Affiliation(s)
| | - Martin Gillies
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Michael Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Alex L Green
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Tipu Aziz
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
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DiLorenzo DJ, Jankovic J, Simpson RK, Takei H, Powell SZ. Neurohistopathological Findings at the Electrode-Tissue Interface in Long-Term Deep Brain Stimulation: Systematic Literature Review, Case Report, and Assessment of Stimulation Threshold Safety. Neuromodulation 2014; 17:405-18; discussion 418. [DOI: 10.1111/ner.12192] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/25/2014] [Accepted: 03/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Joseph Jankovic
- Department of Neurology; Baylor College of Medicine; Houston TX USA
| | | | - Hidehiro Takei
- Department of Pathology; The Methodist Hospital; Houston TX USA
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Wenning GK, Geser F, Krismer F, Seppi K, Duerr S, Boesch S, Köllensperger M, Goebel G, Pfeiffer KP, Barone P, Pellecchia MT, Quinn NP, Koukouni V, Fowler CJ, Schrag A, Mathias CJ, Giladi N, Gurevich T, Dupont E, Ostergaard K, Nilsson CF, Widner H, Oertel W, Eggert KM, Albanese A, del Sorbo F, Tolosa E, Cardozo A, Deuschl G, Hellriegel H, Klockgether T, Dodel R, Sampaio C, Coelho M, Djaldetti R, Melamed E, Gasser T, Kamm C, Meco G, Colosimo C, Rascol O, Meissner WG, Tison F, Poewe W. The natural history of multiple system atrophy: a prospective European cohort study. Lancet Neurol 2013; 12:264-74. [PMID: 23391524 PMCID: PMC3581815 DOI: 10.1016/s1474-4422(12)70327-7] [Citation(s) in RCA: 362] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multiple system atrophy (MSA) is a fatal and still poorly understood degenerative movement disorder that is characterised by autonomic failure, cerebellar ataxia, and parkinsonism in various combinations. Here we present the final analysis of a prospective multicentre study by the European MSA Study Group to investigate the natural history of MSA. METHODS Patients with a clinical diagnosis of MSA were recruited and followed up clinically for 2 years. Vital status was ascertained 2 years after study completion. Disease progression was assessed using the unified MSA rating scale (UMSARS), a disease-specific questionnaire that enables the semiquantitative rating of autonomic and motor impairment in patients with MSA. Additional rating methods were applied to grade global disease severity, autonomic symptoms, and quality of life. Survival was calculated using a Kaplan-Meier analysis and predictors were identified in a Cox regression model. Group differences were analysed by parametric tests and non-parametric tests as appropriate. Sample size estimates were calculated using a paired two-group t test. FINDINGS 141 patients with moderately severe disease fulfilled the consensus criteria for MSA. Mean age at symptom onset was 56·2 (SD 8·4) years. Median survival from symptom onset as determined by Kaplan-Meier analysis was 9·8 years (95% CI 8·1-11·4). The parkinsonian variant of MSA (hazard ratio [HR] 2·08, 95% CI 1·09-3·97; p=0·026) and incomplete bladder emptying (HR 2·10, 1·02-4·30; p=0·044) predicted shorter survival. 24-month progression rates of UMSARS activities of daily living, motor examination, and total scores were 49% (9·4 [SD 5·9]), 74% (12·9 [8·5]), and 57% (21·9 [11·9]), respectively, relative to baseline scores. Autonomic symptom scores progressed throughout the follow-up. Shorter symptom duration at baseline (OR 0·68, 0·5-0·9; p=0·006) and absent levodopa response (OR 3·4, 1·1-10·2; p=0·03) predicted rapid UMSARS progression. Sample size estimation showed that an interventional trial with 258 patients (129 per group) would be able to detect a 30% effect size in 1-year UMSARS motor examination decline rates at 80% power. INTERPRETATION Our prospective dataset provides new insights into the evolution of MSA based on a follow-up period that exceeds that of previous studies. It also represents a useful resource for patient counselling and planning of multicentre trials.
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Affiliation(s)
- Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Petrovic IN, Ling H, Asi Y, Ahmed Z, Kukkle PL, Hazrati LN, Lang AE, Revesz T, Holton JL, Lees AJ. Multiple system atrophy-parkinsonism with slow progression and prolonged survival: a diagnostic catch. Mov Disord 2012; 27:1186-90. [PMID: 22806758 DOI: 10.1002/mds.25115] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/23/2012] [Accepted: 06/14/2012] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Multiple system atrophy (MSA) is a neurodegenerative disease leading to severe physical impairment, with a disease duration from onset to death of 6-9 years. METHODS The clinical and neuropathological features of 4 MSA cases with disease duration of 15 years or more were analyzed. RESULTS All patients presented with parkinsonism and had a mean latency of 11 years before the development of dysautonomia. Mean duration from onset of first symptoms to anterocollis, inspiratory stridor, and dysphagia was 9 years. Despite the limited levodopa response, all patients developed levodopa-induced dyskinesia. CONCLUSIONS Late appearance of dysautonomia is a favorable prognostic factor in MSA-P. Greater awareness of this uncommon "benign" subgroup of MSA will improve diagnostic accuracy and help to more accurately inform treatment options.
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Affiliation(s)
- Igor N Petrovic
- National Hospital for Neurology and Neurosurgery, Queen Square, and the Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, United Kingdom
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Flabeau O, Meissner WG, Tison F. Multiple system atrophy: current and future approaches to management. Ther Adv Neurol Disord 2011; 3:249-63. [PMID: 21179616 DOI: 10.1177/1756285610375328] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Multiple system atrophy (MSA) is a rare neurodegenerative disorder without any effective treatment in slowing or stopping disease progression. It is characterized by poor levodopa responsive Parkinsonism, cerebellar ataxia, pyramidal signs and autonomic failure in any combination. Current therapeutic strategies are primarily based on dopamine replacement and improvement of autonomic failure. However, symptomatic management remains disappointing and no curative treatment is yet available. Recent experimental evidence has confirmed the key role of alpha-synuclein aggregation in the pathogenesis of MSA. Referring to this hypothesis, transgenic and toxic animal models have been developed to assess candidate drugs for MSA. The standardization of diagnosis criteria and assessment procedures will allow large multicentre clinical trials to be conducted. In this article we review the available symptomatic treatment, recent results of studies investigating potential neuroprotective drugs, and future approaches for the management in MSA.
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Affiliation(s)
- Olivier Flabeau
- Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
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Acar F, Acar G, Bir LS, Gedik B, Oğuzhanoğlu A. Deep brain stimulation of the pedunculopontine nucleus in a patient with freezing of gait. Stereotact Funct Neurosurg 2011; 89:214-9. [PMID: 21597312 DOI: 10.1159/000326617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 10/11/2010] [Indexed: 11/19/2022]
Abstract
CASE PRESENTATION A 54-year-old male patient presenting probable multiple system atrophy with predominant parkinsonism who underwent bilateral deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) is presented. The patient had dominant freezing of gait (FOG), levodopa-resistant bradykinesia, and autonomic disturbances, but with a good cognitive condition. METHODS The patient underwent bilateral DBS of the PPN, which ended with modest benefits. RESULTS AND CONCLUSION Although he had a short postoperative follow-up (6 months), his neurological status remained stable and PPN DBS provided modest improvements in the gait disorder and freezing episodes. This unusual case suggests that the mesencephalic pedunculopontine region may have a role in locomotor symptoms and the potential to provide a limited improvement in FOG.
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Affiliation(s)
- Feridun Acar
- Department of Neurosurgery, Medical School, Pamukkale University, Denizli, Turkey
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Levy R, Lozano AM, Lang AE, Dostrovsky JO. Event-related desynchronization of motor cortical oscillations in patients with multiple system atrophy. Exp Brain Res 2010; 206:1-13. [PMID: 20821197 DOI: 10.1007/s00221-010-2312-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 05/22/2010] [Indexed: 10/19/2022]
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disease characterized by parkinsonism (MSA-P), cerebellar and autonomic deficits. In Parkinson's disease (PD), an impaired modulation of motor cortical mu and beta range oscillations may be related to the pathophysiology of bradykinesia. Event-related desynchronization (ERD) of these oscillations occur for 1-2 s preceding a voluntary movement in normal subjects and patients with PD treated with levodopa while only lasting around 0.5 s in untreated patients. Motor cortical rhythms were recorded from subdural strip electrodes in three patients with MSA-P while taking their regular dopaminergic medications. Following a ready cue, patients performed an externally cued wrist extension movement to a go cue. In addition, recordings were obtained during imagined wrist extension movements to the same cues and during self-paced wrist extensions. ERD and event-related synchronization were examined in subject-specific frequency bands. All patients showed movement-related ERD in subject-specific frequency bands below ~40 Hz in both externally cued and self-paced conditions. Preparatory ERD latency preceding self-cued movement was 900 ms in one patient and at or after movement onset in the other two patients. In the externally cued task, a short lasting (<1.3 s) ready cue-related ERD that was not sustained to movement onset was observed in two patients. Imagined movements resulted in go cue-related ERD with a smaller magnitude in the same two patients. These results indicate that the modulation of motor cortical oscillations in patients with MSA that are treated with levodopa is similar to that occurring in untreated patients with PD. The findings suggest that cortical activation in patients with MSA is diminished, may be related to pathophysiological changes occurring in the basal ganglia and correlates with the poor clinical response that these patients typically obtain with dopaminergic therapy.
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Affiliation(s)
- Ron Levy
- Division of Neurosurgery, Department of Clinical Neuroscience, Faculty of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, T2N 2T9, Canada
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Derrey S, Lefaucheur R, Chastan N, Gérardin E, Hannequin D, Desbordes M, Maltête D. Alleviation of off-period dystonia in Parkinson disease by a microlesion following subthalamic implantation. J Neurosurg 2010; 112:1263-6. [DOI: 10.3171/2009.10.jns091032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
A collision/implantation or microlesion effect is commonly described after subthalamic nucleus (STN) implantation for high-frequency stimulation, and this is presumed to reflect disruption of cells and/or fibers. Off-period dystonia, a frequent cause of disability in patients with advanced Parkinson disease, can lead to the need for surgical treatment. The authors assessed the early effect of this microlesion on off-period dystonia.
Methods
The authors assessed 30 consecutive patients with the advanced levodopa-responsive form of Parkinson disease. The patients' symptoms were Hoehn and Yahr Scale score ≥ 3, the mean duration of their disease was 11.4 ± 3.5 years, and they had undergone bilateral implantation of electrodes within the STN for high-frequency stimulation between February 2004 and December 2006. The microlesion effect was defined by the clinical improvement (Unified Parkinson's Disease Rating Scale [UPDRS] Part III score, UPDRS Part IV, item 35) assessed the morning of the 3rd day following STN implantation, after at least a 12-hour withdrawal of dopaminergic treatment and before the programmable pulse generator was switched on (off-drug/off-stimulation mode).
Results
Compared with baseline (off state), the microlesion effect improved the motor score (UPDRS Part III) by 27%. Subscores for tremor, rigidity, and bradykinesia respectively improved by 42, 37, and 25%. Nineteen patients (63%) suffered from off-period dystonia before surgery. Twelve (41%) reported complete relief of their symptoms in the immediate postoperative period and remained free of painful off-period dystonia throughout the 6-month follow-up period.
Conclusions
The author postulated that off-period dystonia alleviation may reflect both a microsubthalamotomy and micropallidotomy effect. They hypothesize, moreover, that the microlesion could play a role in the 6-month postoperative outcome.
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Affiliation(s)
| | | | | | | | | | - Marie Desbordes
- 6Department of Psychiatry, Rouen University Hospital and University of Rouen, France
| | - David Maltête
- 2Neurology,
- 5Inserm U614, Rouen Faculty of Medicine; and
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Bergmann KJ, Salak VL. Subthalamic stimulation improves levodopa responsive symptoms in a case of progressive supranuclear palsy. Parkinsonism Relat Disord 2008; 14:348-52. [PMID: 17825599 DOI: 10.1016/j.parkreldis.2007.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 07/03/2007] [Accepted: 07/07/2007] [Indexed: 11/22/2022]
Abstract
A case is described of a patient with levodopa responsive parkinsonism, dyskinesia, and off periods who underwent bilateral deep brain stimulation of the subthalamic nuclei (DBS-STN) with good result. As the disease progressed, the patient fit diagnostic criteria for progressive supranuclear palsy parkinsonism (PSP-P). Benefit of DBS for the parkinsonian phenomena is still apparent 4 years later. That DBS-STN provided targeted symptom relief in this unusual patient suggests that the parkinsonism of PSP-P and that of Parkinson's disease (PD) may share a common pathophysiologic mechanism. The presence of dystonic features in this illness raises the possibility that the globus pallidus might also have been an effective target.
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Affiliation(s)
- Kenneth J Bergmann
- Murray Center for Research on Parkinson's Disease and Related Disorders, Movement Disorders Program, Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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Maltête D, Derrey S, Chastan N, Debono B, Gérardin E, Fréger P, Mihout B, Menard JF, Hannequin D. Microsubthalamotomy: An immediate predictor of long-term subthalamic stimulation efficacy in Parkinson disease. Mov Disord 2008; 23:1047-1050. [DOI: 10.1002/mds.22054] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Lambrecq V, Krim E, Meissner W, Guehl D, Tison F. [Deep-brain stimulation of the internal pallidum in multiple system atrophy]. Rev Neurol (Paris) 2008; 164:398-402. [PMID: 18439935 DOI: 10.1016/j.neurol.2008.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 09/07/2007] [Accepted: 01/11/2008] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The experience with deep-brain stimulation (DBS) in multiple-system atrophy (MSA) is sparse and generally disappointing. DBS is currently not recommended in MSA and its use is often related to a misdiagnosis. OBSERVATION We describe the outcome of bilateral DBS of the internal pallidum in a 46-year-old woman suffering from MSA that initially resembled Parkinson's disease with prominent levodopa-induced dyskinesias. DBS of the left internal pallidum was performed in 1998 after a ten-year clinical course and improved dyskinesias. Six months later, the right side was implanted. A few months after the second surgery, the patient progressively developed signs of cerebellar and dysautonomic impairment and MSA was diagnosed. CONCLUSION Our observation confirms the ineffectiveness of DBS of the internal pallidum in MSA and even suggests a harmful effect. DBS remains contra-indicated in atypical parkinsonism.
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Affiliation(s)
- V Lambrecq
- Département de neurologie, groupe hospitalier sud, CHU de Bordeaux, Bordeaux, France
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Abstract
Deep brain stimulation (DBS) has gained widespread acceptance for improving motor function and disability in Parkinson's disease (PD). Patients with features suggestive of atypical parkinsonism (AP) usually have a poorer and less sustained response to levodopa and a poorer prognosis overall when compared with patients with PD. However, experience in the use of DBS with this group of patients is limited and evidence is lacking with regards to its efficacy and adverse effects. We review in detail the experience of DBS surgery in patients with several forms of AP including multiple system atrophy. On the basis of the limited available data reviewed here, DBS for patients with AP is not recommended.
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Affiliation(s)
- Ludy C Shih
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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