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Hapakova L, Necpal J, Kosutzka Z. The antisaccadic paradigm: A complementary neuropsychological tool in basal ganglia disorders. Cortex 2024; 178:116-140. [PMID: 38991475 DOI: 10.1016/j.cortex.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/20/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024]
Abstract
This review explores the role of the antisaccadic task in understanding inhibitory mechanisms in basal ganglia disorders. It conducts a comparative analysis of saccadic profiles in conditions such as Parkinson's disease, Tourette syndrome, obsessive-compulsive disorder, Huntington's disease, and dystonia, revealing distinct patterns and proposing mechanisms for impaired performance. The primary focus is on two inhibitory mechanisms: global, pre-emptive inhibition responsible for suppressing prepotent responses, and slower, selective response inhibition. The antisaccadic task demonstrates practicality in clinical applications, aiding in differential diagnoses, treatment monitoring and reflecting gait control. To further enhance its differential diagnostic value, future directions should address issues such as the standardization of eye-tracking protocol and the integration of eye-tracking data with other disease indicators in a comprehensive dataset.
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Affiliation(s)
- Lenka Hapakova
- 2nd Department of Neurology, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
| | - Jan Necpal
- Neurology Department, Hospital Zvolen, a. s., Zvolen, Slovakia.
| | - Zuzana Kosutzka
- 2nd Department of Neurology, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
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2
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Aihemaitiniyazi A, Zhang H, Hu Y, Li T, Liu C. Quality of life outcomes after deep brain stimulation in acquired dystonia: a systematic review and meta-analysis. Neurol Sci 2024; 45:467-476. [PMID: 37816931 PMCID: PMC10791872 DOI: 10.1007/s10072-023-07106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Dystonia is a condition that affects the ability to control the movement and function of the body's muscles. It can cause not only physical problems, but also mental problems, resulting in impaired health-related quality of life (HRQoL). However, the effect of deep brain stimulation on quality of life in acquired dystonia remains unclear. METHODS We conducted a systematic literature review from January 2000 to October 2022,determined the eligible studies, and performed a meta-analysis of HRQoL outcomes based on the Short-Form Health Survey-36 (SF-36) after DBS to evaluate the effects of DBS on physical and mental QoL. RESULTS A total of 14 studies met the inclusion criteria and were systematically reviewed. A comprehensive meta-analysis was performed for 9 studies that reported physical and psychological data or physical component summary (PCS), or mental component summary (MCS) for SF-36. The mean (SD) age at DBS implantation was 34.29 (10.3) years, and the follow-up period after implantation was 2.21 (2.80) years. The random effects model meta-analysis revealed that both physical and mental domains of the SF-36 improved following DBS. There was no statistically significant difference between the physical domains (effect size=1.34; p<0.0001) and the mental domains (effect size=1.38; p<0.0001). CONCLUSION This is the first meta-analysis that demonstrates significant benefits in HRQoL following DBS in patients with acquired dystonia. There were significant improvements in both physical QoL and mental QoL.
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Affiliation(s)
| | - Huawei Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yue Hu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Aviation General Hospital, China Medical University, Beijing, 100012, China
| | - Tiemin Li
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Changqing Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
- Department of Neurosurgery, Chongqing Sanbo Jiangling Hospital, Chongqing, China.
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Liu B, Xu J, Yang H, Yu X, Mao Z. PAllidal versus SubThalamic deep brain Stimulation for Cervical Dystonia (PASTS-CD): study protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e073425. [PMID: 37832982 PMCID: PMC10582967 DOI: 10.1136/bmjopen-2023-073425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) has been validated as a safe and effective treatment for refractory cervical dystonia (CD). Globus pallidus internus (GPi) and subthalamic nucleus (STN) are the two main stimulating targets. However, there has been no prospective study to clarify which target is the better DBS candidate for CD. The objective of this trial is to compare directly the efficacy and safety of GPi-DBS and STN-DBS, thereby instructing the selection of DBS target in clinical practice. METHODS AND ANALYSIS This multicentre, prospective, randomised, controlled study plans to enrol 98 refractory CD patients. Eligible CD patients will be randomly allocated to GPi-DBS group or STN-DBS group, with the DBS electrodes implanted into the posteroventral portion of GPi or the dorsolateral portion of STN, respectively. The primary outcome will be the improvement of symptomatic severity, measured by the changes in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity subscale and the Tsui scale at 3 months, 6 months and 12 months after surgery. The secondary outcomes include the improvement of the TWSTRS-disability subscale, TWSTRS-pain subscale, quality of life, mental and cognitive condition, as well as the differences in stimulation parameters and adverse effects. In addition, this study intends to identify certain predictors of DBS efficacy for CD. ETHICS AND DISSEMINATION The trial has been approved by the Medical Ethics Committee of Chinese PLA General Hospital (S2022-613-01). The results of this study will be published in international peer-reviewed journals and shared in professional medical conferences. TRIAL REGISTRATION NUMBER NCT05715138.
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Affiliation(s)
- Bin Liu
- Medical School, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junpeng Xu
- Medical School, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haonan Yang
- Medical School, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
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Khanom AA, Franceschini PR, Lane S, Osman-Farah J, Macerollo A. Bilateral globus pallidus internus (GPi) deep brain stimulation for cervical dystonia: Effects on motor and non-motor symptoms within 5 years follow. J Neurol Sci 2023; 452:120752. [PMID: 37542824 DOI: 10.1016/j.jns.2023.120752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/04/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Cervical Dystonia ("CD") is a movement disorder characterised by sustained muscle contractions in the neck, causing involuntary posturing. Deep brain stimulation ("DBS") of the globus pallidal internus (GPi) is advanced treatment for pharmaco-refractory patients. As CD is a rare disease, cohort studies are often limited to patients of heterogenous disease profile, small sample size or short follow-up. This study firstly aimed to measure the efficacy of GPi-DBS on motor and non-motor symptoms of CD. A secondary aim was to evaluate if clinical factors - such as age, disease duration and baseline disease severity - influence variability of motor outcomes. METHODS 37 idiopathic CD patients were recruited from movement disorders clinics at The Walton NHS Foundation Trust, Liverpool, UK. Patients were assessed pre-operatively, and 1 year, 3 years and 5 years post-operatively with the following clinical scales: Toronto Western Spasmodic Torticollis Rating Scale ("TWSTRS"), Hospital Anxiety and Depression Scale and EuroQuol-5D. RESULTS GPI-DBS significantly improved overall TWSTRS scores by 57% from baseline to 5Y FU (p < 0.001). It also significantly improved TWSTRS severity, disability, and pain sub-scores by 72%, 59% and 46% respectively. We did not find a significant improvement in mood or quality of life scores at 5 years. Similarly, clinical factors at baseline did not correlate with variability in motor outcome. CONCLUSION We concluded that GPi-DBS is an effective treatment for motor symptoms and pain in CD. There was limited effect on mood and QoL, and no clinical predictive factors of outcome were identified.
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Affiliation(s)
- Anjum Aarifa Khanom
- University of Liverpool Medical School, Liverpool, UK; The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK
| | - Paulo Roberto Franceschini
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK; Functional Neurosurgery Department, Universidade de Caxias do Sul, Brazil
| | - Steven Lane
- Institute of Data Health Sciences, University of Liverpool, UK
| | - Jibril Osman-Farah
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK
| | - Antonella Macerollo
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK.
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Lin S, Shu Y, Zhang C, Wang L, Huang P, Pan Y, Ding J, Sun B, Li D, Wu Y. Globus pallidus internus versus subthalamic nucleus deep brain stimulation for isolated dystonia: A 3-year follow-up. Eur J Neurol 2023; 30:2629-2640. [PMID: 37235703 DOI: 10.1111/ene.15895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND PURPOSE Bilateral deep brain stimulation (DBS) surgery targeting the globus pallidus internus (GPi) or the subthalamic nucleus (STN) is widely used in medication-refractory dystonia. However, evidence regarding target selection considering various symptoms remains limited. This study aimed to compare the effectiveness of these two targets in patients with isolated dystonia. METHODS This retrospective study evaluated 71 consecutive patients (GPi-DBS group, n = 32; STN-DBS group, n = 39) with isolated dystonia. Burke-Fahn-Marsden Dystonia Rating Scale scores and quality of life were evaluated preoperatively and at 1, 6, 12, and 36 months postoperatively. Cognition and mental status were assessed preoperatively and at 36 months postoperatively. RESULTS Targeting the STN (STN-DBS) yielded effects within 1 month (65% vs. 44%; p = 0.0076) and was superior at 1 year (70% vs. 51%; p = 0.0112) and 3 years (74% vs. 59%; p = 0.0138). For individual symptoms, STN-DBS was preferable for eye involvement (81% vs. 56%; p = 0.0255), whereas targeting the GPi (GPi-DBS) was better for axis symptoms, especially for the trunk (82% vs. 94%; p = 0.015). STN-DBS was also favorable for generalized dystonia at 36-month follow-up (p = 0.04) and required less electrical energy (p < 0.0001). Disability, quality of life, and depression and anxiety measures were also improved. Neither target influenced cognition. CONCLUSIONS We demonstrated that the GPi and STN are safe and effective targets for isolated dystonia. The STN has the benefits of fast action and low battery consumption, and is superior for ocular dystonia and generalized dystonia, while the GPi is better for trunk involvement. These findings may offer guidance for future DBS target selection for different types of dystonia.
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Affiliation(s)
- Suzhen Lin
- Department of Neurology & Institute of Neurology, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yimei Shu
- Department of Neurology & Institute of Neurology, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingbing Wang
- Department of Neurology & Institute of Neurology, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianqing Ding
- Department of Neurology & Institute of Neurology, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology & Institute of Neurology, RuiJin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sedov A, Gamaleya A, Semenova U, Medvednik R, Tomskiy A, Jinnah HA, Shaikh A. Does Pallidal Physiology Determine the Success of Unilateral Deep Brain Stimulation in Cervical Dystonia? ADVANCES IN NEUROBIOLOGY 2023; 31:211-221. [PMID: 37338704 DOI: 10.1007/978-3-031-26220-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Pallidal deep brain stimulation is a well-known surgical treatment for cervical dystonia. The resolution of dystonia typically requires bilateral pallidal stimulation, but in some instances, unilateral stimulation has been successful. In such instances, generally, the stimulated hemisphere was contralateral to the dystonic sternocleidomastoid, but rarely it was ipsilateral. We sought for the physiological features that determine the basis for success and laterality of deep brain stimulation for cervical dystonia with prominent torticollis. We found that pallidal physiology such as high burst to tonic ratio and significant interhemispheric differences in the neuronal firing rate and regularity are critical determinants of successful treatment with unilateral deep brain stimulation. We also found that higher lateralized differences in pallidal physiological parameters predict more robust improvement. In three out of four patients, the stimulation of the hemisphere ipsilateral to the dystonic sternocleidomastoid muscle was effective. These patients did not have any structural brain abnormalities on clinically available imaging studies. One patient responded to the unilateral deep brain stimulation in the hemisphere contralateral to the dystonic sternocleidomastoid. This patient had a structural putamen lesion on brain MRI. These results provide objective parameters determining the success of pallidal deep brain stimulation for treatment of cervical dystonia. The results also depict differences in the pallidal physiology in patients where ipsilateral versus contralateral deep brain stimulation was effective.
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Affiliation(s)
- Alexey Sedov
- Semenov Research Center of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
- Phystech school of biological and medical physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | - Anna Gamaleya
- N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Ulia Semenova
- Semenov Research Center of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Rita Medvednik
- Semenov Research Center of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Alexey Tomskiy
- N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | | | - Aasef Shaikh
- Departments of Neurology and Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Neurological Institute, University Hospitals, Cleveland, OH, USA
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
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Long-term efficacy with deep brain stimulation of the globus pallidus internus in cervical dystonia: a retrospective monocentric study. Neurol Res Pract 2022; 4:48. [PMID: 36184607 PMCID: PMC9528120 DOI: 10.1186/s42466-022-00214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical dystonia (CD) is characterized by involuntary contractions of the cervical muscles. Data on long-term effectiveness of deep brain stimulation (DBS) are rare. The aim of this study was to evaluate the longitudinal ten years treatment efficacy of DBS in the globus pallidus internus (GPI). METHODS A retrospective single-center data analysis was performed on patients with idiopathic CD, who were treated with GPI DBS for at least 10 years. TWSTR severity score and individual sub-items were compared between pre and post DBS surgery (n = 15) over time. RESULTS There was a significant and persistent positive effect regarding the severity of TWSTRS between the conditions immediately before and 1, 5, and 10 years after establishment of GPI DBS (mean difference: 6.6-7 ± 1.6). Patients with increasing CD complexity showed a poorer response to established treatment forms, such as injection of botulinum toxin and were thus DBS candidates. Especially a predominant torticollis was significantly improved by DBS. CONCLUSION GPI DBS is an effective procedure especially in severely affected patients with a positive 10-year outcome. It should be considered in more complex CD-forms or predominant torticollis.
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Martinez-Nunez AE, Sidiropoulos C, Wall J, Schwalb J, Air E, LeWitt P, Bulica B, Kaminski P, Patel N. Adjuvant medical therapy in cervical dystonia after deep brain stimulation: A retrospective analysis. Front Neurol 2022; 13:927573. [PMID: 35989908 PMCID: PMC9389307 DOI: 10.3389/fneur.2022.927573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThere is limited information on optimization of symptomatic management of cervical dystonia (CD) after implantation of pallidal deep brain stimulation (DBS).ObjectivesTo describe the long-term, “real-world” management of CD patients after DBS implantation and the role of reintroduction of pharmacologic and botulinum toxin (BoNT) therapy.MethodsA retrospective analysis of patients with focal cervical or segmental craniocervical dystonia implanted with DBS was conducted.ResultsNine patients were identified with a mean follow-up of 41.7 ± 15.7 months. All patients continued adjuvant oral medication(s) to optimize symptom control post-operatively. Three stopped BoNT and four reduced BoNT dose by an average of 22%. All patients remained on at least one medication used to treat dystonia post-operatively.ConclusionOptimal symptom control was achieved with DBS combined with either BoNT and/or medication. We suggest utilization of adjuvant therapies such as BoNT and/or medications if DBS monotherapy does not achieve optimal symptom control.
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Affiliation(s)
- Alfonso E. Martinez-Nunez
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States
- *Correspondence: Alfonso E. Martinez-Nunez
| | - Christos Sidiropoulos
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, United States
| | - Julia Wall
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States
| | - Jason Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, United States
| | - Ellen Air
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, United States
| | - Peter LeWitt
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Bisena Bulica
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States
| | - Patricia Kaminski
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States
| | - Neepa Patel
- Parkinson's Disease and Movement Disorders Program, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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9
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Bilateral subthalamic nucleus deep brain stimulation for refractory isolated cervical dystonia. Sci Rep 2022; 12:7678. [PMID: 35538160 PMCID: PMC9090754 DOI: 10.1038/s41598-022-11841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/28/2022] [Indexed: 11/08/2022] Open
Abstract
Subthalamic nucleus (STN) deep brain stimulation (DBS) has been proven to be an alternative target choice for refractory isolated cervical dystonia (CD). However, assessments of its short and long-term safety, efficacy, and sustained effectiveness have been limited to few reports. Here, we evaluated nine consecutive refractory isolated CD patients who underwent bilateral STN DBS and accepted to short and long-term follow-up in this retrospective study. Seven time points were used to see the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores (pre-operation [baseline], 1, 3, 6, 12, 24 months post-operation and last follow-up) to assess improvement of dystonic symptoms. The 36-item Short-Form General Health Survey (SF-36) scores obtained at pre-operation and last follow-up to assess the changes in quality of life. All patients tolerated surgery well and acquired observable clinical benefits from STN DBS therapy. All patients achieved a considerable improvement in quality of life at the last follow-up. The hardware-related adverse events can be tolerated and the stimulation-related adverse events can be ameliorated by programming. Our data support the idea that bilateral STN DBS is a safety and effective method for the treatment of refractory isolated CD, with persistent and remarkable improvement in both movement and quality of life.
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Holanda VM, Eisinger RS, Almeida L, Tsuboi T, Wang H, Okun MS, Deeb W, Patterson A, Wagle Shukla A, Lobo Lopes J, Foote KD. Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience. Front Neurol 2021; 12:679918. [PMID: 34456844 PMCID: PMC8387620 DOI: 10.3389/fneur.2021.679918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/05/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: The aim of this study is to evaluate the evolution of GPi DBS targeting. Methods: This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases. Each patient underwent a high-resolution targeting study on the day prior to the surgery, which was fused with a high resolution CT scan that was acquired on the day of the procedure. Intraoperative target location was selected using a digitized 3D Schaltenbrand-Bailey atlas. All patients underwent a high-resolution head CT scan without contrast approximately one month after lead implantation and accurate measurement of neuroanatomical lead position was acquired after fusion of pre-operative and post-operative image studies. Results: We analyzed 253 PD patients with 352 leads and 80 dystonia patients with 141 leads. During 15 years of follow-up, lead locations in the PD group migrated more laterally (β = 0.09, p < 0.0001), posteriorly [slope (β) = 0.04, p < 0.05], and dorsally (β = 0.07, p < 0.001), whereas leads in the dystonia group did not significantly change position aside from a trend in the dorsal direction (β = 0.06, p = 0.053). Conclusion: The evolving target likely results from multiple factors including improvements in targeting techniques and clinical feedback intraoperatively and post-operatively. Our demonstrates the potential importance of a systematic post-operative DBS lead measurement protocol to ensure quality control and to inform and optimize DBS programming.
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Affiliation(s)
- Vanessa M Holanda
- Department of Neurosurgery, Center of Neurology and Neurosurgery Associates (NeuroCENNA), Beneficencia Portuguesa of São Paulo Hospital, São Paulo, Brazil
| | - Robert Stephen Eisinger
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Takashi Tsuboi
- Department of Neurology, Nagoya University, Nagoya, Japan
| | - Huimin Wang
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Wissam Deeb
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Addie Patterson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Aparna Wagle Shukla
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Janine Lobo Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Kelly Douglas Foote
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
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Kamel WA, Majumdar P, Matis G, Fenoy AJ, Balakrishnan S, Zirh AT, Cevik A, Tomar AK, Ouerchefani N. Surgical Management for Dystonia: Efficacy of Deep Brain Stimulation in the Long Term. Neurol Int 2021; 13:371-386. [PMID: 34449699 PMCID: PMC8395937 DOI: 10.3390/neurolint13030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Dystonia is a movement disorder substantially affecting the quality of life. Botulinum Neurotoxin (BoNT) is used intramuscularly as a treatment for dystonia; however, not all dystonia patients respond to this treatment. Deep brain stimulation (DBS) is an established treatment for Parkinson’s disease (PD) and essential tremor, but it can help in dystonia as well. Objectives: We studied a total of 67 dystonia patients who were treated with DBS over a period of 7 years to find out the long-term efficacy of DBS in those patients. First, we calculated patient improvement in post-surgery follow-up programs using the Global Dystonia Severity scale (GDS) and Burke–Fahn–Marsden dystonia rating scale (BFMDRS). Secondly, we analyzed the scales scores to see if there was any statistical significance. Methods: In our study we analyzed patients with ages from 38 to 78 years with dystonia who underwent DBS surgery between January 2014 and December 2020 in four different centers (India, Kuwait, Egypt, and Turkey). The motor response to DBS surgery was retrospectively measured for each patient during every follow-up visit using the GDS and the BFMDRS scales. Results: Five to 7 years post-DBS, the mean reduction in the GDS score was 30 ± 1.0 and for the BFMDRS score 26 ± 1.0. The longitudinal change in scores at 12 and 24 months post-op was also significant with mean reductions in GDS and BFMDRS scores of 68 ± 1.0 and 56 ± 1.0, respectively. The p-values were <0.05 for our post-DBS dystonia patients. Conclusions: This study illustrates DBS is an established, effective treatment option for patients with different dystonias, such as generalized, cervical, and various brain pathology-induced dystonias. Although symptoms are not completely eliminated, continuous improvements are noticed throughout the post-stimulation time frame.
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Affiliation(s)
- Walaa A. Kamel
- Neurology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62511, Egypt;
- Neurology Department, Ibn-Sina Hospital, Kuwait City 25427, Kuwait
| | - Pritam Majumdar
- Department of Stereotactic and Functional Neurosurgery, University Cologne Hospital, 50931 Cologne, Germany;
- Correspondence:
| | - Georgios Matis
- Department of Stereotactic and Functional Neurosurgery, University Cologne Hospital, 50931 Cologne, Germany;
| | - Albert J. Fenoy
- Department of Neurosurgery, McGovern Medical School, The University of Texas at Houston, UTHealth Neurosciences, Houston, TX 77030, USA;
| | - Shankar Balakrishnan
- Department of Neurology and Neuromodulation, MIOT International Hospital, Hennai 600089, India;
| | - Ali T. Zirh
- Department of Neurosurgery, Istanbul Medipol University, Istanbul 34810, Turkey;
| | - Aslihan Cevik
- Department of Neurosurgery, Istanbul Aydin University, Istanbul Medical Park Florya, Istanbul 34295, Turkey;
| | - Amit Kumar Tomar
- Department of Anesthesia and Neurosurgery, Indo-Gulf Hospital, Noida 201301, India;
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12
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Blahak C, Wolf ME, Saryyeva A, Baezner H, Krauss JK. Improvement of head and neck range of motion induced by chronic pallidal deep brain stimulation for cervical dystonia. J Neural Transm (Vienna) 2021; 128:1205-1213. [PMID: 34231038 DOI: 10.1007/s00702-021-02365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has become an accepted treatment for severe cervical dystonia (CD). Assessment of therapeutic efficacy of DBS mostly focused on head position at rest but hardly on limitations of head and neck mobility, which represent a functionally important impairment in CD. OBJECTIVE We aimed to determine prospectively head and neck range of motion (ROM) preoperatively and during chronic bilateral GPi DBS in a series of 11 patients with idiopathic CD or segmental dystonia with prominent CD using a computerized motion analysis. METHODS Maximum horizontal rotation of the head in the transverse plane and lateral inclination in the frontal plane were measured preoperatively and at a median of 7 months of chronic GPi DBS, using an ultrasound-based three-dimensional measuring system combined with surface electromyography of cervical muscles. RESULTS Horizontal rotation of the head increased from 78.8° ± 31.5° (mean ± SD) preoperatively to 100.7° ± 24.7° with GPi DBS (p < 0.01), thereby improvement of head rotation to the anti-dystonic side (+ 14,2° ± 12,2°) was greater than to the pro-dystonic side (+ 7,8° ± 9,2°; p < 0.05). Movement-related agonistic-antagonistic EMG modulation during head rotation was enhanced with GPi DBS in both sternocleidomastoid (modulation index (MI) 35.8% ± 26.7% preoperatively vs. 67.3% ± 16.9% with GPi DBS, p < 0.01), and splenius capitis muscles (MI 1.9% ± 24.5% preoperatively vs. 44.8% ± 11.6% with GPi DBS, p < 0.01). CONCLUSION Chronic bilateral GPi DBS significantly improves head ROM in CD, likely due to enhanced agonist-antagonist EMG activity with reduced co-contraction. Computerized motion analysis provides an objective measurement to assess the improvement of head and neck mobility in CD.
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Affiliation(s)
- Christian Blahak
- Department of Neurology, UniversitaetsMedizin Mannheim, University of Heidelberg, Mannheim, Germany.
- Department of Neurology, Ortenau-Klinikum Lahr, Klostenstrasse 19, 7933, Lahr, Germany.
| | - Marc E Wolf
- Department of Neurology, UniversitaetsMedizin Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Neurology, Klinikum Stuttgart, Stuttgart, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Hansjoerg Baezner
- Department of Neurology, UniversitaetsMedizin Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Neurology, Klinikum Stuttgart, Stuttgart, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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13
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Kim HJ, Jeon B. Arching deep brain stimulation in dystonia types. J Neural Transm (Vienna) 2021; 128:539-547. [PMID: 33740122 DOI: 10.1007/s00702-021-02304-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/11/2020] [Indexed: 12/29/2022]
Abstract
Although medical treatment including botulinum toxic injection is the first-line treatment for dystonia, response is insufficient in many patients. In these patients, deep brain stimulation (DBS) can provide significant clinical improvement. Mounting evidence indicates that DBS is an effective and safe treatment for dystonia, especially for idiopathic and inherited isolated generalized/segmental dystonia, including DYT-TOR1A. Other inherited dystonia and acquired dystonia also respond to DBS to varying degrees. For Meige syndrome (craniofacial dystonia), other focal dystonia, and some rare inherited dystonia, further evidences are still needed to evaluate the role of DBS. Because short disease duration at DBS surgery and absence of fixed musculoskeletal deformity are associated with better outcome, DBS should be considered as early as possible when indicated after careful evaluation including genetic work-up. This review will focus on the factors to be considered in DBS for patients with dystonia and the outcome of DBS in the different types of dystonia.
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Affiliation(s)
- Han-Joon Kim
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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14
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Sui Y, Tian Y, Ko WKD, Wang Z, Jia F, Horn A, De Ridder D, Choi KS, Bari AA, Wang S, Hamani C, Baker KB, Machado AG, Aziz TZ, Fonoff ET, Kühn AA, Bergman H, Sanger T, Liu H, Haber SN, Li L. Deep Brain Stimulation Initiative: Toward Innovative Technology, New Disease Indications, and Approaches to Current and Future Clinical Challenges in Neuromodulation Therapy. Front Neurol 2021; 11:597451. [PMID: 33584498 PMCID: PMC7876228 DOI: 10.3389/fneur.2020.597451] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 01/17/2023] Open
Abstract
Deep brain stimulation (DBS) is one of the most important clinical therapies for neurological disorders. DBS also has great potential to become a great tool for clinical neuroscience research. Recently, the National Engineering Laboratory for Neuromodulation at Tsinghua University held an international Deep Brain Stimulation Initiative workshop to discuss the cutting-edge technological achievements and clinical applications of DBS. We specifically addressed new clinical approaches and challenges in DBS for movement disorders (Parkinson's disease and dystonia), clinical application toward neurorehabilitation for stroke, and the progress and challenges toward DBS for neuropsychiatric disorders. This review highlighted key developments in (1) neuroimaging, with advancements in 3-Tesla magnetic resonance imaging DBS compatibility for exploration of brain network mechanisms; (2) novel DBS recording capabilities for uncovering disease pathophysiology; and (3) overcoming global healthcare burdens with online-based DBS programming technology for connecting patient communities. The successful event marks a milestone for global collaborative opportunities in clinical development of neuromodulation to treat major neurological disorders.
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Affiliation(s)
- Yanan Sui
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Ye Tian
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Wai Kin Daniel Ko
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Zhiyan Wang
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Fumin Jia
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Andreas Horn
- Charité, Department of Neurology, Movement Disorders and Neuromodulation Unit, University Medicine Berlin, Berlin, Germany
| | - Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ki Sueng Choi
- Department of Psychiatry and Behavioural Science, Emory University, Atlanta, GA, United States.,Department of Radiology, Mount Sinai School of Medicine, New York, NY, United States.,Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, United States
| | - Ausaf A Bari
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kenneth B Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Andre G Machado
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Tipu Z Aziz
- Department of Neurosurgery, John Radcliffe Hospital, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Erich Talamoni Fonoff
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.,Hospital Sírio-Libanês and Hospital Albert Einstein, São Paulo, Brazil
| | - Andrea A Kühn
- Charité, Department of Neurology, Movement Disorders and Neuromodulation Unit, University Medicine Berlin, Berlin, Germany
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada (IMRIC), Faculty of Medicine, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research (ELSC), The Hebrew University and Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Terence Sanger
- University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Hesheng Liu
- Department of Neuroscience, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Suzanne N Haber
- Department of Pharmacology and Physiology, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States.,McLean Hospital and Harvard Medical School, Belmont, MA, United States
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
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15
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Li H, Wang T, Zhang C, Su D, Lai Y, Sun B, Li D, Wu Y. Asleep Deep Brain Stimulation in Patients With Isolated Dystonia: Stereotactic Accuracy, Efficacy, and Safety. Neuromodulation 2020; 24:272-278. [PMID: 33325608 DOI: 10.1111/ner.13341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Lead placement for deep brain stimulation (DBS) is routinely performed using neuroimaging or microelectrode recording (MER). Recent studies have demonstrated that DBS under general anesthesia using an imaging-guided target technique ("asleep" DBS) can be performed accurately and effectively with lower surgery complication rates than the MER-guided target method under local anesthesia ("awake" DBS). This suggests that asleep DBS may be a more acceptable method. However, there is limited direct evidence focused on isolated dystonia using this method. Therefore, this study aimed to investigate the clinical outcomes and targeting accuracy in patients with dystonia who underwent asleep DBS. MATERIALS AND METHODS We examined 56 patients (112 leads) with isolated dystonia who underwent asleep DBS targeting in the globus pallidus internus (GPi) and subthalamic nucleus (STN). The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores were assessed preoperatively and at 12-month follow-up (12 m-FU). The lead accuracy was evaluated by comparing the coordinates of the preoperative plan with those of the final electrode implantation location. Other measures analyzed included stimulation parameters and adverse events (AEs). RESULTS For both GPi and STN cohorts, mean BFMDRS motor scores were significantly lower at 12 m-FU (8.9 ± 10.9 and 4.6 ± 5.7 points) than at baseline (22.6 ± 16.4 and 16.1 ± 14.1 points, p < 0.001). The mean difference between the planned target and the distal contact of the leads was 1.33 ± 0.54 mm for the right brain electrodes and 1.50 ± 0.57 mm for the left, determined by Euclidian distance. No perioperative complications or AEs related to the device were observed during the complete follow-up. However, AEs associated with stimulation occurred in 12 and 6 patients in the GPi and STN groups, respectively. CONCLUSIONS Asleep DBS may be an accurate, effective, and safe method for treating patients with isolated dystonia regardless of the stimulation target.
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Affiliation(s)
- Hongxia Li
- Department of Neurology & Institute of Neurology, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daoqing Su
- Department of Neurosurgery, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng, China
| | - Yijie Lai
- Department of Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology & Institute of Neurology, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
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16
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Kaelin-Lang A, You H, Burgunder JM, Lönnfors-Weitze T, Loher TJ, Taub E, Isaias IU, Krauss JK, Michael Schüpbach W. Bilateral pallidal stimulation improves cervical dystonia for more than a decade. Parkinsonism Relat Disord 2020; 81:78-81. [DOI: 10.1016/j.parkreldis.2020.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
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17
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Tsuboi T, Cauraugh JH, Wong JK, Okun MS, Ramirez-Zamora A. Quality of life outcomes after globus pallidus internus deep brain stimulation in idiopathic or inherited isolated dystonia: a meta-analysis. J Neurol Neurosurg Psychiatry 2020; 91:938-944. [PMID: 32732389 DOI: 10.1136/jnnp-2019-322575] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/08/2020] [Accepted: 06/10/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Several studies reported the beneficial effects of globus pallidus internus deep brain stimulation (GPi DBS) on health-related quality of life (HRQoL) in patients with inherited or idiopathic isolated dystonia. However, the impact of this intervention on physical and mental/psychological domains and the effects over time remain unclear. METHODS We conducted a systematic literature review from January 2000 to May 2019 and performed a meta-analysis of HRQoL outcomes based on the Short Form Health Survey-36 (SF-36) after GPi DBS in patients with inherited or idiopathic isolated dystonia to evaluate the effects of DBS on physical and mental QoL. RESULTS Seven studies comprising 144 patients with dystonia (78, generalised; 34, segmental; and 32, focal cervical) were included in this comprehensive analysis. The mean (SD) age at DBS implantation was 41.0 (11.4) years, and the follow-up period after implantation was 3.2 (3.8) years. The random effects model meta-analysis revealed that both physical and mental domains of SF-36 improved following DBS with a significantly larger effect size for the physical domains (effect size=0.781; p<0.0001) compared with the mental domains (effect size=0.533; p<0.0001). A moderator variable analysis demonstrated that effect sizes for HRQoL improvement were maintained over time. CONCLUSIONS This is the first meta-analysis that demonstrates significant benefits in HRQoL following DBS in patients with inherited or idiopathic isolated dystonia. The benefits are greater for physical QoL domains compared with mental/psychological QoL. These findings highlight the importance of a comprehensive multidisciplinary approach to improve mental/psychological QoL.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA .,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - James H Cauraugh
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Joshua K Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
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18
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Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis. J Neurol 2020; 267:1780-1792. [PMID: 32140866 DOI: 10.1007/s00415-020-09765-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) therapy has been suggested to be a beneficial alternative in cervical dystonia (CD) for patients who failed nonsurgical treatments. This individual patient data meta-analysis compared the efficacy of DBS in the globus pallidus internus (GPi) versus subthalamic nucleus (STN) and identified possible predictive factors for CD. METHODS Three electronic databases (PubMed, Embase and Web of Science) were searched for studies with no publication date restrictions. The primary outcomes were normalized by calculating the relative change in TWSTRS total scores and subscale scores at the last follow-up. Data were analyzed mainly using Pearson's correlation coefficients and a stepwise multivariate regression analysis. RESULTS Thirteen studies (86 patients, 58 with GPi-DBS and 28 with STN-DBS) were eligible. Patients showed significant improvement in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) (52.5 ± 11.6 vs 21.9 ± 14.9, P < 0.001) scores at the last follow-up (22.0 ± 14.3 months), compared with scores at baseline, with a mean improvement of 56.6% (P < 0.001) (54.9% in severity, 63.2% in disability, 41.7% in pain). There was no significant difference in the improvement (%) of the total TWSTRS scores in 3 years for the GPI and STN groups (58.1 ± 22.6 vs 47.5 ± 39.2, P > 0.05). Age at surgery and age at symptom onset were negatively correlated with the relative changes in TWSTRS scores at the last follow-up, while there was a positive correlation with preoperative TWSTRS scores. On the stepwise multivariate regression, only the age at surgery remained significant in the best predictive model. CONCLUSIONS GPi-DBS and STN-DBS both provided a common great improvement in the symptoms of CD patients in 3 years. Earlier age at surgery may probably indicate larger improvement. More randomized large-scale clinical trials are warranted in the future.
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19
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Reich MM, Horn A, Lange F, Roothans J, Paschen S, Runge J, Wodarg F, Pozzi NG, Witt K, Nickl RC, Soussand L, Ewert S, Maltese V, Wittstock M, Schneider GH, Coenen V, Mahlknecht P, Poewe W, Eisner W, Helmers AK, Matthies C, Sturm V, Isaias IU, Krauss JK, Kühn AA, Deuschl G, Volkmann J. Probabilistic mapping of the antidystonic effect of pallidal neurostimulation: a multicentre imaging study. Brain 2020; 142:1386-1398. [PMID: 30851091 DOI: 10.1093/brain/awz046] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/12/2018] [Accepted: 01/08/2019] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation of the internal globus pallidus is a highly effective and established therapy for primary generalized and cervical dystonia, but therapeutic success is compromised by a non-responder rate of up to 25%, even in carefully-selected groups. Variability in electrode placement and inappropriate stimulation settings may account for a large proportion of this outcome variability. Here, we present probabilistic mapping data on a large cohort of patients collected from several European centres to resolve the optimal stimulation volume within the pallidal region. A total of 105 dystonia patients with pallidal deep brain stimulation were enrolled and 87 datasets (43 with cervical dystonia and 44 with generalized dystonia) were included into the subsequent 'normative brain' analysis. The average improvement of dystonia motor score was 50.5 ± 30.9% in cervical and 58.2 ± 48.8% in generalized dystonia, while 19.5% of patients did not respond to treatment (<25% benefit). We defined probabilistic maps of anti-dystonic effects by aggregating individual electrode locations and volumes of tissue activated (VTA) in normative atlas space and ranking voxel-wise for outcome distribution. We found a significant relation between motor outcome and the stimulation volume, but not the electrode location per se. The highest probability of stimulation induced motor benefit was found in a small volume covering the ventroposterior globus pallidus internus and adjacent subpallidal white matter. We then used the aggregated VTA-based outcome maps to rate patient individual VTAs and trained a linear regression model to predict individual outcomes. The prediction model showed robustness between the predicted and observed clinical improvement, with an r2 of 0.294 (P < 0.0001). The predictions deviated on average by 16.9 ± 11.6 % from observed dystonia improvements. For example, if a patient improved by 65%, the model would predict an improvement between 49% and 81%. Results were validated in an independent cohort of 10 dystonia patients, where prediction and observed benefit had a correlation of r2 = 0.52 (P = 0.02) and a mean prediction error of 10.3% (±8.9). These results emphasize the potential of probabilistic outcome brain mapping in refining the optimal therapeutic volume for pallidal neurostimulation and advancing computer-assisted planning and programming of deep brain stimulation.
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Affiliation(s)
- Martin M Reich
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany.,Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | - Florian Lange
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | - Jonas Roothans
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | | | | | - Fritz Wodarg
- University Kiel, Department of Radiology, Germany
| | - Nicolo G Pozzi
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | - Karsten Witt
- University Kiel, Department of Neurology, Germany.,University Oldenburg, Department of Neurology, Germany
| | - Robert C Nickl
- Julius-Maximilians-University, Department of Neurosurgery, Germany
| | - Louis Soussand
- Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Siobhan Ewert
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | - Virgina Maltese
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | | | - Gerd-Helge Schneider
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | - Volker Coenen
- Freiburg University Medical Center, Department of Stereotactic and Functional Neurosurgery, Germany
| | | | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Austria
| | - Wilhelm Eisner
- Department of Neurosurgery, Innsbruck Medical University, Austria
| | | | - Cordula Matthies
- Julius-Maximilians-University, Department of Neurosurgery, Germany
| | - Volker Sturm
- Julius-Maximilians-University, Department of Neurosurgery, Germany
| | - Ioannis U Isaias
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | | | - Andrea A Kühn
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | | | - Jens Volkmann
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
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20
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Treatment of severe refractory dystonic tremor associated with cervical dystonia by bilateral deep brain stimulation: A case series report. Clin Neurol Neurosurg 2020; 190:105644. [DOI: 10.1016/j.clineuro.2019.105644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 11/08/2019] [Accepted: 12/16/2019] [Indexed: 11/21/2022]
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21
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Wang X, Mao Z, Ling Z, Yu X. Predictive factors for outcome of pallidal deep brain stimulation in cervical dystonia. Clin Neurol Neurosurg 2020; 192:105720. [PMID: 32036265 DOI: 10.1016/j.clineuro.2020.105720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Primary cervical dystonia (CD) is characterized by abnormal contractions of neck muscles. Globus pallidus internus deep brain stimulation (GPi-DBS) is recognized as an effective therapy for patients with refractory CD, but the prognostic factors need further research. Our study investigated the predictive factors of clinical outcomes in CD patients who underwent GPi-DBS. PATIENTS AND METHODS Patients (n = 23) who underwent GPi-DBS at Chinese PLA General Hospital from March 2012 to April 2018 were included in our analysis. Their scores of Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Tsui were acquired at baseline and at the last follow-up visit. Percent improvement in these scores were compared between the categorical variables. Correlations between outcomes and continuous demographic and clinical variables were calculated. RESULTS Patients showed significant improvement in TWSTRS total (55.71 %), severity (48.75 %), disability (57.05 %), pain (63.67 %) scores and total Tsui score (46.07 %, all P ﹤0.001). Follow-up duration was positively correlated with percent improvement in TWSTRS total (rho = 0.594, P = 0.003), severity (rho = 0.581, P = 0.004) and disability (rho = 0.470, P = 0.023) scores. No significant differences in the outcomes were found between any pair of the categorical variables. CONCLUSIONS Follow-up duration was the only independent factor correlated to the outcomes of GPi-DBS for CD patients. However, follow-up duration is an indefinite factor prior to surgery, thus further studies are needed before the final conclusions of prognostic factors are established.
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Affiliation(s)
- Xin Wang
- School of Medicine, Nankai University, Tianjin, China; Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhipei Ling
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- School of Medicine, Nankai University, Tianjin, China; Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
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22
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Tsuboi T, Wong JK, Almeida L, Hess CW, Wagle Shukla A, Foote KD, Okun MS, Ramirez-Zamora A. A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia. J Neurol 2020; 267:1278-1290. [DOI: 10.1007/s00415-020-09703-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/24/2022]
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23
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Wojtasiewicz T, Butala A, Anderson WS. Dystonia. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Range of voluntary neck motility predicts outcome of pallidal DBS for cervical dystonia. Acta Neurochir (Wien) 2019; 161:2491-2498. [PMID: 31659440 DOI: 10.1007/s00701-019-04076-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/13/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The effectiveness of pallidal deep brain stimulation (GPi DBS) for cervical dystonia has been extensively described, but controversies exist about which prognostic factor is clinically useful. We previously reported that classification of tonic- or phasic-type cervical dystonia is useful for predicting clinical prognosis; however, the approach used by physicians to distinguish between the two types remains subjective. OBJECTIVE The aim of this study was to develop a prognostic factor of GPi DBS for cervical dystonia. METHODS By identifying distributions of range of motion scores between phasic- and tonic-type cervical dystonia, a new prognostic factor group was developed based on whether the patients could voluntarily move their head to the opposite side against dystonic motions. The prognosis for GPi DBS in the two groups was analyzed according to the time sequence. RESULTS Patients who were able to move their head past the midline had a better long-term prognosis after GPi DBS than did those who could not. In the early post-operative phase, there were no significant differences in the clinical outcomes between the two groups. CONCLUSION A range of voluntary neck motility with respect to the midline is an objective factor that is useful in predicting the prognosis of patients with cervical dystonia. This result renders needs for future study addressing neuroplastic changes in the brain network caused by GPi DBS.
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Tsuboi T, Wong JK, Okun MS, Ramirez-Zamora A. Quality of life outcomes after deep brain stimulation in dystonia: A systematic review. Parkinsonism Relat Disord 2019; 70:82-93. [PMID: 31767450 DOI: 10.1016/j.parkreldis.2019.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/07/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022]
Abstract
Dystonia is an incurable movement disorder which can cause not only physical but also mental problems, leading to impaired health-related quality of life (HRQoL). For patients with dystonia refractory to medical treatment, deep brain stimulation (DBS) is a well-established surgical treatment. The objective of this systematic review is to provide a better understanding of HRQoL outcomes after DBS for dystonia. A search of the literature was conducted using Medline (PubMed), Embase, and Cochrane Library databases in May 2019. HRQoL outcomes after DBS along with motor outcomes were reported in a total of 36 articles involving 610 patients: 21 articles on inherited or idiopathic isolated dystonia, 5 on tardive dystonia, 3 on cerebral palsy, 2 on myoclonus-dystonia, 1 on X-linked dystonia-parkinsonism, and 3 on mixed cohorts of different dystonia subtypes. DBS improved motor symptoms in various subtypes of dystonia. Most studies on patients with inherited or idiopathic isolated dystonia showed significant improvement in physical QoL, whereas gains in mental QoL were less robust and likely related to the complexity of associated neuropsychiatric problems. HRQoL outcomes beyond 5 years remain scarce. Although the studies on patients with other subtypes of dystonia also demonstrated improvement in HRQoL after DBS, the interpretation is difficult because of a limited number of articles with small cohorts. Most articles employed generic measures (e.g. Short Form Health Survey-36) and this highlights the critical need to develop and to utilize sensitive and disease-specific HRQoL measures. Finally, long-term HRQoL outcomes and predictors of HRQoL should also be clarified.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Joshua K Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Ortiz RM, Scheperjans F, Pekkonen E. Deep brain stimulation for dystonia in Finland during 2007-2016. BMC Neurol 2019; 19:137. [PMID: 31234792 PMCID: PMC6589889 DOI: 10.1186/s12883-019-1370-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/18/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Dystonia is a movement disorder substantially affecting the quality of life and the ability to work. A proportion of patients does not respond to first line pharmacotherapy. Deep brain stimulation (DBS) is established as a primary operative treatment option for severe drug resistant dystonia. We studied dystonia patients treated with DBS in Finland between the years 2007-2016 to evaluate the use and outcomes of DBS treatment. METHODS We analysed the hospital records of dystonia patients, who underwent DBS operation during 2007-2016 in Finland. The clinical and technical parameters were recorded as well as preoperative assessments and treatments. The response to DBS was evaluated retrospectively using the Global Dystonia Rating Scale (GDS). RESULTS Out of 585 dB implantations during the study period, 37 were done for dystonia. The clinical response improved significantly with time in the isolated focal dystonia group, and at 12 months, 22 of 32 patients had over 50% alleviation of the GDS score. There was only one subclinical intracerebral haemorrhage, and four infections leading to revision. Speech impairment and limb coordination problems were common stimulation- related adverse events and were mostly resolved or relieved with the adjustment of stimulation parameters. CONCLUSIONS DBS seems to be beneficial in dystonia. Although DBS is indicated for dystonia in Finland, the number of operations did not increase at the same rate as DBS operations in general. DBS appears to be a safe and effective treatment for focal as well as generalized dystonia.
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Affiliation(s)
- Rebekka M Ortiz
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland. .,Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland.
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland.,Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland.,Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
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Bally JF, Rohani M, Ruiz-Lopez M, Paramanandam V, Munhoz RP, Hodaie M, Kalia SK, Lozano AM, Burkhard PR, Poncet A, Fasano A. Patient-adjusted deep-brain stimulation programming is time saving in dystonia patients. J Neurol 2019; 266:2423-2429. [PMID: 31197514 DOI: 10.1007/s00415-019-09423-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/29/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Deep-brain stimulation (DBS) programming for dystonia patients is a complex and time-consuming task. OBJECTIVE To analyze whether programming a programming paradigm based on patient's self-adjustment is practical, effective and time saving in dystonia. METHODS We retrospectively compared dystonia rating scales as well as the time necessary to optimize programming and the number of in-hospital visits in all patients (n = 102) operated at our center who used simple mode (SM) or advanced mode (AM) programming; the latter uses groups of different stimulation parameters and allows the patient and their caregiver to change stimulation groups at home, using the patient remote control. RESULTS Both AM- and SM-allocated patients improved clinically to the same extent after DBS, as assessed by the Burke-Fahn-Marsden (BFM) and the Toronto Western Spasmodic Torticollis (TWSTRS) dystonia rating scales. All subscores improved after DBS without statistically significant differences in improvement between AM and SM (BFM: - 43% vs. - 53%, p = 0.569; TWSTRS: - 63% vs. - 72%, p = 0.781). AM and SM patients reached optimization within a similar median time [5.5 months (95% CI 4.6-6.3) for AM vs. 6.2 months (4.2-7.6) for SM, p = 0.674) but patients on advanced programming needed fewer in-hospital visits to achieve the same improvement [median of 5 visits (95% CI 4-7) for AM vs. 8 visits (7-9) for SM, p = 0.008]. CONCLUSIONS Advanced DBS programming based on patient's self-adjustment under the supervision of the treating physician is feasible, practical and significantly reduces consultation time in dystonia patients.
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Affiliation(s)
- Julien F Bally
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst St, 7McL412, Toronto, ON, M5T 2S8, Canada.,Department of Neurology, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Mohamad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Marta Ruiz-Lopez
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst St, 7McL412, Toronto, ON, M5T 2S8, Canada.,University Hospital Fundación Jimenez Diaz, Madrid, Spain
| | - Vijayashankar Paramanandam
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst St, 7McL412, Toronto, ON, M5T 2S8, Canada
| | - Renato P Munhoz
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst St, 7McL412, Toronto, ON, M5T 2S8, Canada.,Krembil Brain Institute, Toronto, ON, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada
| | - Pierre R Burkhard
- Department of Neurology, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Antoine Poncet
- CRC & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Alfonso Fasano
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst St, 7McL412, Toronto, ON, M5T 2S8, Canada. .,Krembil Brain Institute, Toronto, ON, Canada. .,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
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Tsuboi T, Jabarkheel Z, Foote KD, Okun MS, Wagle Shukla A. Importance of the initial response to GPi deep brain stimulation in dystonia: A nine year quality of life study. Parkinsonism Relat Disord 2019; 64:249-255. [PMID: 31060987 DOI: 10.1016/j.parkreldis.2019.04.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Long-term efficacy of deep brain stimulation (DBS) on health-related quality-of-life (HRQoL) for isolated dystonia is not well established. This study aims to determine the long-term impact of DBS on HRQoL outcomes and identify clinical predictors. METHODS We retrospectively investigated 16 inherited or idiopathic isolated dystonia patients treated with bilateral globus pallidus internus DBS who were followed beyond 9 years at our center. The cohort consisted of 9 males, 7 females; 10 generalized, 6 segmental; mean (range) age at implantation, 37.0 (8-67) years; mean follow-up duration after implantation, 10.9 (9-13) years. We employed the Unified Dystonia Rating Scale for motor and Short Form Health Survey for HRQoL assessments to monitor the change longitudinally. We analyzed the changes in motor and HRQoL at 1-2 years (short-term) and ≥9 years (long-term) follow-up as compared to baseline with a Wilcoxon signed-rank test. We assessed the factors that predicted motor and HRQoL improvement with univariate regression analyses. RESULTS Motor (41.6%; p = 0.004) and HRQoL (total score, p = 0.039) improvements remained significant at long-term follow-up and, in the regression analysis, change in HRQoL outcomes correlated significantly with change in motor outcomes (R2 = 0.384, p = 0.010). Additionally, short-term motor and HRQoL improvements predicted the long-term motor (R2 = 0.384, p = 0.010) and HRQoL (total score, R2 = 0.594, p < 0.001) outcomes, respectively. CONCLUSION Motor and HRQoL improvements with DBS in isolated dystonia remain sustained for nearly a decade and may largely be predictable by the short-term response to DBS.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Zakia Jabarkheel
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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Ravindran K, Ganesh Kumar N, Englot DJ, Wilson TJ, Zuckerman SL. Deep Brain Stimulation Versus Peripheral Denervation for Cervical Dystonia: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 122:e940-e946. [PMID: 30419402 DOI: 10.1016/j.wneu.2018.10.178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/26/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cervical dystonia is a disabling medical condition that drastically decreases quality of life. Surgical treatment consists of peripheral nerve denervation procedures with or without myectomies or deep brain stimulation (DBS). The current objective was to compare the efficacy of peripheral denervation versus DBS in improving the severity of cervical dystonia through a systematic review and meta-analysis. METHODS A search of PubMed, MEDLINE, EMBASE, and Web of Science electronic databases was conducted in accordance with PRISMA guidelines. Preoperative and postoperative Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total scores were used to generate standardized mean differences and 95% confidence intervals (CIs), which were combined in a random-effects model. Both mean percentage and absolute reduction in TWSTRS scores were calculated. Absolute reduction was used for forest plots. RESULTS Eighteen studies met the inclusion criteria, comprising 870 patients with 180 (21%) undergoing DBS and 690 (79%) undergoing peripheral denervation procedures. The mean follow-up time was 31.5 months (range, 12-38 months). In assessing the efficacy of each intervention, forest plots revealed significant absolute reduction in total postoperative TWSTRS scores for both peripheral denervation (standardized mean difference 1.54; 95% CI 1.42-1.66) and DBS (standardized mean difference 2.07; 95% CI 1.43-2.71). On subgroup analysis, DBS therapy was significantly associated with improvement in postoperative TWSTRS severity (standardized mean difference 2.08; 95% CI 1.66-2.50) and disability (standardized mean difference 2.12; 95% CI 1.57-2.68) but not pain (standardized mean difference 1.18; 95% CI 0.80-1.55). CONCLUSIONS Both peripheral denervation and DBS are associated with a significant reduction in absolute TWSTRS total score, with no significant difference in the magnitude of reduction observed between the 2 treatments. Further comparative data are needed to better evaluate the long-term results of both interventions.
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Affiliation(s)
- Krishnan Ravindran
- Department of Neurosurgery, Vanderbilt University Medical Center School, Nashville, Tennessee, USA
| | - Nishant Ganesh Kumar
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Dario J Englot
- Department of Neurosurgery, Vanderbilt University Medical Center School, Nashville, Tennessee, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center School, Nashville, Tennessee, USA.
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Eggink H, Szlufik S, Coenen MA, van Egmond ME, Moro E, Tijssen MA. Non-motor effects of deep brain stimulation in dystonia: A systematic review. Parkinsonism Relat Disord 2018; 55:26-44. [DOI: 10.1016/j.parkreldis.2018.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/17/2018] [Accepted: 06/16/2018] [Indexed: 12/15/2022]
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Mahlknecht P, Georgiev D, Akram H, Brugger F, Vinke S, Zrinzo L, Hariz M, Bhatia KP, Hariz GM, Willeit P, Rothwell JC, Foltynie T, Limousin P. Parkinsonian signs in patients with cervical dystonia treated with pallidal deep brain stimulation. Brain 2018; 141:3023-3034. [DOI: 10.1093/brain/awy217] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Philipp Mahlknecht
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Dejan Georgiev
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurology, Medical University Ljubljana, Ljubljana, Slovenia
| | - Harith Akram
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Florian Brugger
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Saman Vinke
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Gun-Marie Hariz
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Peter Willeit
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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Rusz J, Tykalová T, Fečíková A, Šťastná D, Urgošík D, Jech R. Dualistic effect of pallidal deep brain stimulation on motor speech disorders in dystonia. Brain Stimul 2018; 11:896-903. [DOI: 10.1016/j.brs.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/24/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022] Open
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Cury RG, Kalia SK, Shah BB, Jimenez-Shahed J, Prashanth LK, Moro E. Surgical treatment of dystonia. Expert Rev Neurother 2018; 18:477-492. [PMID: 29781334 DOI: 10.1080/14737175.2018.1478288] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Treatment of dystonia should be individualized and tailored to the specific needs of patients. Surgical treatment is an important option in medically refractory cases. Several issues regarding type of the surgical intervention, targets, and predict factors of benefit are still under debate. Areas covered: To date, several clinical trials have proven the benefit and safety of deep brain stimulation (DBS) for inherited and idiopathic isolated dystonia, whereas there is still insufficient evidence in combined and acquired dystonia. The globus pallidus internus (GPi) is the target with the best evidence, but data on the subthalamic nucleus seems also to be promising. Evidence suggests that younger patients with shorter disease duration experience greater benefit following DBS. Pallidotomy and thalamotomy are currently used in subset of carefully selected patients. The development of MRI-guided focused ultrasound might bring new options to ablation approach in dystonia. Expert commentary: GPi-DBS is effective and safe in isolated dystonia and should not be delayed when symptoms compromise quality of life and functionality. Identifying the best candidates to surgery on acquired and combined dystonias is still necessary. New insights about pathophysiology of dystonia and new technological advances will undoubtedly help to tailor surgery and optimize clinical effects.
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Affiliation(s)
- Rubens Gisbert Cury
- a Service de Neurologie, Centre Hospitalier Universitaire de Grenoble , Université Grenoble Alpes , Grenoble , France.,b Department of Neurology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Suneil Kumar Kalia
- c Division of Neurosurgery and Krembil Research Institute, Department of Surgery , University of Toronto , Toronto , Canada
| | - Binit Bipin Shah
- d Parkinson's Disease and Movement Disorders Center, Department of Neurology , University of Virginia , Charlottesville , VA , USA
| | - Joohi Jimenez-Shahed
- e Parkinson's Disease Center and Movement Disorders Clinic , Baylor College of Medicine , Houston , TX , USA
| | | | - Elena Moro
- a Service de Neurologie, Centre Hospitalier Universitaire de Grenoble , Université Grenoble Alpes , Grenoble , France
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Ni Z, Kim SJ, Phielipp N, Ghosh S, Udupa K, Gunraj CA, Saha U, Hodaie M, Kalia SK, Lozano AM, Lee DJ, Moro E, Fasano A, Hallett M, Lang AE, Chen R. Pallidal deep brain stimulation modulates cortical excitability and plasticity. Ann Neurol 2018; 83:352-362. [DOI: 10.1002/ana.25156] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Zhen Ni
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Sang Jin Kim
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Nicolas Phielipp
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Soumya Ghosh
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Kaviraja Udupa
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Carolyn A. Gunraj
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Utpal Saha
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto and Krembil Research Institute; University Health Network; Toronto Ontario Canada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto and Krembil Research Institute; University Health Network; Toronto Ontario Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto and Krembil Research Institute; University Health Network; Toronto Ontario Canada
| | - Darrin J. Lee
- Division of Neurosurgery, Department of Surgery, University of Toronto and Krembil Research Institute; University Health Network; Toronto Ontario Canada
| | - Elena Moro
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
- Neurology Department; University Hospital Center Grenoble, Grenoble Alpes University, National Institute of Health and Medical Research; U1214 Grenoble France
| | - Alfonso Fasano
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital; Toronto Ontario Canada
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health; Bethesda MD
| | - Anthony E. Lang
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital; Toronto Ontario Canada
| | - Robert Chen
- Division of Neurology, Department of Medicine; University Health Network; Toronto Ontario Canada
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital; Toronto Ontario Canada
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Alterman RL, Stone S. Deep Brain Stimulation for Dystonia. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Jitkritsadakul O, Bhidayasiri R, Kalia SK, Hodaie M, Lozano AM, Fasano A. Systematic review of hardware-related complications of Deep Brain Stimulation: Do new indications pose an increased risk? Brain Stimul 2017; 10:967-976. [DOI: 10.1016/j.brs.2017.07.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/21/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023] Open
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Lozano AM, Hutchison WD, Kalia SK. What Have We Learned About Movement Disorders from Functional Neurosurgery? Annu Rev Neurosci 2017; 40:453-477. [DOI: 10.1146/annurev-neuro-070815-013906] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario M5T 2S8, Canada;, ,
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - William D. Hutchison
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario M5T 2S8, Canada;, ,
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario M5T 2S8, Canada;, ,
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
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Reese R, Volkmann J. Deep Brain Stimulation for the Dystonias: Evidence, Knowledge Gaps, and Practical Considerations. Mov Disord Clin Pract 2017; 4:486-494. [PMID: 30363085 PMCID: PMC6090587 DOI: 10.1002/mdc3.12519] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/10/2017] [Accepted: 06/17/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the globus pallidus internus (GPi-DBS) is among the most effective treatment options for dystonias. Because the term "dystonia" is defined by a characteristic phenomenology of involuntary muscle contractions, which may present with a large clinical and pathogenetic heterogeneity, decision making for or against GPi-DBS can be difficult in individual patients. METHODS A search of the PubMed database for research and review articles, focused on "deep brain stimulation" and "dystonia" was used to identify clinical trials and to determine current concepts in the surgical management of dystonia. Patient selection in previous studies was recategorized by the authors using the new dystonia classification put forward by a consensus committee of experts in dystonia research. The evidence and knowledge gaps are summarized and commented by the authors taking into account expert opinion and personal clinical experience for providing practical guidance in patient selection for DBS in dystonia. RESULTS The literature review shows that pallidal deep brain stimulation is most effective in patients with isolated dystonia irrespective of the underlying etiology. In contrast, patients with combined dystonias are less likely to benefit from DBS, because the associated neurological symptoms (e.g., hypotonia or ataxia), with the exception of myoclonus, do not respond to pallidal neurostimulation. CONCLUSIONS It is important to recognize the clinical features of dystonia, because the distinction between isolated and combined dystonia syndromes may predict the treatment response to pallidal deep brain stimulation. The aim of this review is to help guide clinicians with advising patients about deep brain stimulation therapy for dystonia and refering appropriate candidates to surgical centers.
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Affiliation(s)
- René Reese
- Department of NeurologyRostock University Medical CenterRostockGermany
- Department of NeurologyUniversity Hospital WürzburgWürzburgGermany
| | - Jens Volkmann
- Department of NeurologyUniversity Hospital WürzburgWürzburgGermany
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Pauls KAM, Krauss JK, Kämpfer CE, Kühn AA, Schrader C, Südmeyer M, Allert N, Benecke R, Blahak C, Boller JK, Fink GR, Fogel W, Liebig T, El Majdoub F, Mahlknecht P, Kessler J, Mueller J, Voges J, Wittstock M, Wolters A, Maarouf M, Moro E, Volkmann J, Bhatia KP, Timmermann L. Causes of failure of pallidal deep brain stimulation in cases with pre-operative diagnosis of isolated dystonia. Parkinsonism Relat Disord 2017; 43:38-48. [PMID: 28690015 DOI: 10.1016/j.parkreldis.2017.06.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/22/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pallidal deep brain stimulation (GPi-DBS) is an effective therapy for isolated dystonia, but 10-20% of patients show improvement below 25-30%. We here investigated causes of insufficient response to GPi-DBS in isolated dystonia in a cross-sectional study. METHODS Patients with isolated dystonia at time of surgery, and <30% improvement on the Burke-Fahn-Marsden dystonia-rating-scale (BFMDRS) after ≥6 months of continuous GPi-DBS were videotaped ON and OFF stimulation, and history, preoperative videos, brain MRI, medical records, stimulation settings, stimulation system integrity, lead location, and genetic information were obtained and reviewed by an expert panel. RESULTS 22 patients from 11 centres were included (8 men, 14 women; 9 generalized, 9 segmental, 3 focal, 1 bibrachial dystonia; mean (range): age 48.7 (25-72) years, disease duration 22.0 (2-40) years, DBS duration 45.5 (6-131) months). Mean BFMDRS-score was 31.7 (4-93) preoperatively and 32.3 (5-101) postoperatively. Half of the patients (n = 11) had poor lead positioning alone or in combination with other problems (combined with: other disease n = 6, functional dystonia n = 1, other problems n = 2). Other problems were disease other than isolated inherited or idiopathic dystonia (n = 5), fixed deformities (n = 2), functional dystonia (n = 3), and other causes (n = 1). Excluding patients with poor lead location from further analysis, non-isolated dystonia accounted for 45.5%, functional dystonia for 27.3%, and fixed deformities for 18.2%. In patients with true isolated dystonia, lead location was the most frequent problem. CONCLUSION After exclusion of lead placement and stimulation programming issues, non-isolated dystonia, functional dystonia and fixed deformities account for the majority of GPi-DBS failures in dystonia.
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Affiliation(s)
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Andrea A Kühn
- Department of Neurology, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Schrader
- Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Martin Südmeyer
- Department of Neurology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Niels Allert
- Neurological Rehabilitation Center Godeshöhe, Bonn, Germany
| | - Rainer Benecke
- Department of Neurology, Universitätsmedizin Rostock, Rostock, Germany
| | - Christian Blahak
- Department of Neurology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Jana K Boller
- Department of Neurology, Uniklinik Köln, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Uniklinik Köln, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Wolfgang Fogel
- Department of Neurology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Uniklinik Köln, Cologne, Germany
| | - Faycal El Majdoub
- Department of Stereotaxic and Functional Neurosurgery, Uniklinik Köln, Cologne, Germany
| | - Philipp Mahlknecht
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Kessler
- Department of Neurology, Uniklinik Köln, Cologne, Germany
| | - Joerg Mueller
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Juergen Voges
- Department for Stereotactic Neurosurgery, Universitätsklinikum Magdeburg, Magdeburg, Germany; Leibniz Institute of Neurobiology, Magdeburg, Germany
| | | | - Alexander Wolters
- Department of Neurology, Universitätsmedizin Rostock, Rostock, Germany
| | - Mohammad Maarouf
- Department of Stereotaxic and Functional Neurosurgery, Uniklinik Köln, Cologne, Germany
| | - Elena Moro
- Division of Neurology, University Hospital Center of Grenoble, Grenoble, France
| | - Jens Volkmann
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
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Nagy AM, Tolleson CM. Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders. Brain Sci 2016; 6:brainsci6040046. [PMID: 27740598 PMCID: PMC5187560 DOI: 10.3390/brainsci6040046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) is a unique, functional neurosurgical therapy indicated for medication refractory movement disorders as well as some psychiatric diseases. Multicontact electrodes are placed in "deep" structures within the brain with targets varying depending on the surgical indication. An implanted programmable pulse generator supplies the electrodes with a chronic, high frequency electrical current that clinically mimics the effects of ablative lesioning techniques. DBS's efficacy has been well established for its movement disorder indications (Parkinson's disease, essential tremor, and dystonia). However, clinical outcomes are sometimes suboptimal, even in the absence of common, potentially reversible complications such as hardware complications, infection, poor electrode placement, and poor programming parameters. This review highlights some of the rescue procedures that have been explored in suboptimal DBS cases for Parkinson's disease, essential tremor, and dystonia. To date, the data is limited and difficult to generalize, but a large majority of published reports demonstrate positive results. The decision to proceed with such treatments should be made on a case by case basis. Larger studies are needed to clearly establish the benefit of rescue procedures and to establish for which patient populations they may be most appropriate.
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Affiliation(s)
- Adam M Nagy
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN 37232, USA.
| | - Christopher M Tolleson
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN 37232, USA.
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Beaulieu-Boire I, Aquino CC, Fasano A, Poon YY, Fallis M, Lang AE, Hodaie M, Kalia SK, Lozano A, Moro E. Deep Brain Stimulation in Rare Inherited Dystonias. Brain Stimul 2016; 9:905-910. [PMID: 27743838 DOI: 10.1016/j.brs.2016.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/01/2016] [Accepted: 07/21/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Rare causes of inherited movement disorders often present with a debilitating phenotype of dystonia, sometimes combined with parkinsonism and other neurological signs. Since these disorders are often resistant to medications, DBS may be considered as a possible treatment. METHODS Patients with identified genetic diseases (ataxia-telangiectasia, chorea-achantocytosis, dopa-responsive dystonia, congenital nemaline myopathy, methylmalonic aciduria, neuronal ceroid lipofuscinosis, spinocerebellar ataxia types 2 and 3, Wilson's disease, Woodhouse-Sakati syndrome, methylmalonic aciduria, and X trisomy) and disabling dystonia underwent bilateral GPi DBS (bilateral thalamic Vim nucleus in 1 case). The primary outcome was the difference in the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) between baseline, 1 year and last available follow-up. Preoperative factors such as age at surgery, disease duration at surgery, proportion of life lived with dystonia and severity of dystonia were correlated to the primary outcome. RESULTS Eleven patients were operated between February 2003 and December 2013. Age and duration of disease at time of surgery were 30 ± 19 and 12.5 ± 15.7 years, respectively. DBS effects on dystonia severity were variable but overall marginally effective, with a mean improvement of 7.9% (p = 0.39) at 1-year follow-up and 16.7% (p = 0.46) at last follow-up (mean 47.3 ± 19.9 months after surgery). No preoperative factors were identified to predict the surgical outcome. CONCLUSION Our findings support the current knowledge that DBS is modestly effective in treating rare inherited dystonias with a combined phenotype. However, the BFMDRS might not be the best tool to measure outcome in these severely affected patients.
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Affiliation(s)
- Isabelle Beaulieu-Boire
- Division of Neurology, Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Québec, Canada; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Camila C Aquino
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
| | - Yu-Yan Poon
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Fallis
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Antony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andres Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Elena Moro
- Division of Neurology, CHU Grenoble, INSERM U836, Joseph Fourier University, Grenoble, France
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Abstract
Surgical procedures for dystonia and tremor have evolved over the past few decades, and our understanding of risk, benefit, and predictive factors has increased substantially in that time. Deep brain stimulation (DBS) is the most utilized surgical treatment for dystonia and tremor, though lesioning remains an effective option in appropriate patients. Dystonic syndromes that have shown a substantial reduction in severity secondary to DBS are isolated dystonia, including generalized, cervical, and segmental, as well as acquired dystonia such as tardive dystonia. Essential tremor is quite amenable to DBS, though the response of other forms of postural and kinetic tremor is not nearly as robust or consistent based on available evidence. Regarding targeting, DBS lead placement in the globus pallidus internus has shown marked efficacy in dystonia reduction. The subthalamic nucleus is an emerging target, and increasing evidence suggests that this may be a viable target in dystonia as well. The ventralis intermedius nucleus of the thalamus is the preferred target for essential tremor, though targeting the subthalamic zone/caudal zona incerta has shown promise and may emerge as another option in essential tremor and possibly other tremor disorders. In the carefully selected patient, DBS and lesioning procedures are relatively safe and effective for the management of dystonia and tremor.
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Affiliation(s)
- Jason L Crowell
- Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA, 22908, USA
| | - Binit B Shah
- Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA, 22908, USA.
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43
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TODA H, SAIKI H, NISHIDA N, IWASAKI K. Update on Deep Brain Stimulation for Dyskinesia and Dystonia: A Literature Review. Neurol Med Chir (Tokyo) 2016; 56:236-48. [PMID: 27053331 PMCID: PMC4870178 DOI: 10.2176/nmc.ra.2016-0002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/01/2016] [Indexed: 12/11/2022] Open
Abstract
Deep brain stimulation (DBS) has been an established surgical treatment option for dyskinesia from Parkinson disease and for dystonia. The present article deals with the timing of surgical intervention, selecting an appropriate target, and minimizing adverse effects. We provide an overview of current evidences and issues for dyskinesia and dystonia as well as emerging DBS technology.
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Affiliation(s)
- Hiroki TODA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Kita, Osaka
| | - Hidemoto SAIKI
- Department of Neurology, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Kita, Osaka
| | - Namiko NISHIDA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Kita, Osaka
| | - Koichi IWASAKI
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Kita, Osaka
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44
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Eligibility Criteria for Deep Brain Stimulation in Parkinson’s Disease, Tremor, and Dystonia. Can J Neurol Sci 2016; 43:462-71. [DOI: 10.1017/cjn.2016.35] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIn this review, the available evidence to guide clinicians regarding eligibility for deep brain stimulation (DBS) in the main conditions in which these forms of therapy are generally indicated—Parkinson’s disease (PD), tremor, and dystonia—is presented. In general, the literature shows that DBS is effective for PD, essential tremor, and idiopathic dystonia. In these cases, key points in patient selection must include the level of disability and inability to manage symptoms using the best available medical therapy. Results are, however, still not optimal when dealing with other aetiologies, such as secondary tremors and symptomatic dystonia. Also, in PD, issues such as age and neuropsychiatric profile are still debatable parameters. Overall, currently available literature is able to guide physicians on basic aspects of patient selection and indications for DBS; however, a few points are still debatable and controversial. These issues should be refined and clarified in future studies.
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45
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Different clinical course of pallidal deep brain stimulation for phasic- and tonic-type cervical dystonia. Acta Neurochir (Wien) 2016; 158:171-80; discussion 180. [PMID: 26611690 DOI: 10.1007/s00701-015-2646-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/16/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dystonia has been treated well using deep brain stimulation at the globus pallidus internus (GPi DBS). Dystonia can be categorized as two basic types of movement, phasic-type and tonic-type. Cervical dystonia is the most common type of focal dystonia, and sequential differences in clinical outcomes between phasic-type and tonic-type cervical dystonia have not been reported. METHODS This study included a retrospective cohort of 30 patients with primary cervical dystonia who underwent GPi DBS. Age, disease duration, dystonia direction, movement types, employment status, relevant life events, and neuropsychological examinations were analyzed with respect to clinical outcomes following GPi DBS. RESULTS The only significant factor affecting clinical outcomes was movement type (phasic or tonic). Sequential changes in clinical outcomes showed significant differences between phasic- and tonic-type cervical dystonia. A delayed benefit was found in both phasic- and tonic-type dystonia. CONCLUSIONS The clinical outcome of phasic-type cervical dystonia is more favorable than that of tonic-type cervical dystonia following GPi DBS.
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46
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Albanese A, Romito LM, Calandrella D. Therapeutic advances in dystonia. Mov Disord 2015; 30:1547-56. [DOI: 10.1002/mds.26384] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alberto Albanese
- Istituto Clinico Humanitas; Rozzano Milano Italy
- Istituto di Neurologia, Università Cattolica del Sacro Cuore; Milano Italy
| | - Luigi M. Romito
- Neurologia I, Istituto Neurologico Carlo Besta; Milano Italy
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47
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Barbey A, Bloch J, Vingerhoets FJG. DBS in Dystonia and Other Hyperkinetic Movement Disorders. Curr Treat Options Neurol 2015; 17:373. [PMID: 26257150 DOI: 10.1007/s11940-015-0373-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT The diagnosis and appropriate treatment of hyperkinetic movement disorders require a work up of potentially reversible metabolic, infectious and structural disorders as well as side effects of current medication. In pharmacoresistant movement disorders with a disabling impact on quality of life, deep brain stimulation (DBS) should be considered. At different targets, DBS has become an established therapy for Parkinson's disease (GPi-STN), tremor (VIM) and primary dystonia (GPi) with reasonable perioperative risks and side effects, established guidelines and some clinical and radiological predictive factors. In contrast, for other hyperkinetic movement disorders, including secondary dystonia, Gilles de la Tourette, chorea and ballism, only few data are available. Definite targets are not well defined, and reported results are of less magnitude than those of the recognized indications. In this expanding therapeutical field without worked out recommendations, an individual approach is needed with DBS indication assessment only after rigorous multidisciplinary scrutiny, restricted to expert centres.
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Affiliation(s)
- A Barbey
- Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue de Bugnon 21, CH-1011, Lausanne, Switzerland
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48
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Schönecker T, Gruber D, Kivi A, Müller B, Lobsien E, Schneider GH, Kühn AA, Hoffmann KT, Kupsch AR. Postoperative MRI localisation of electrodes and clinical efficacy of pallidal deep brain stimulation in cervical dystonia. J Neurol Neurosurg Psychiatry 2015; 86:833-9. [PMID: 25253870 DOI: 10.1136/jnnp-2014-308159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/28/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pallidal deep brain stimulation (DBS) has been shown to be effective in cervical dystonia (CD) with an improvement of about 50-60% in the Toronto Western Spasmodic Torticollis Rating (TWSTR) Scale. However, predictive factors for the efficacy of DBS in CD are missing with the anatomical location of the electrodes being one of the most important potential predictive factors. METHODS In the present blinded observational study we correlated the anatomical localisation of DBS contacts with the relative clinical improvement (CI %) in the TWSTR as achieved by DBS at different pallidal contacts in 20 patients with CD. Localisations of DBS contacts were derived from postoperative MRI-data following anatomical normalisation into the standard Montreal Neurological Institute stereotactic space. The CIs following 76 bilateral test stimulations of 24 h were mapped to stereotactic coordinates of the corresponding bilateral 152 active contacts and were allocated to low CI (<30%; n=74), intermediate CI (≥30%; <60%; n=52) or high CI (≥60%; n=26). RESULTS Euclidean distances between contacts and the centroid differed between the three clusters (p<0.001) indicating different anatomical variances between clusters. The Euclidean distances between contacts and the centroid of the cluster with high CIs correlated with the individual level of CIs (r=-0.61; p<0.0001). This relationship was best fitted with an exponential regression curve (r(2)=0.41). DISCUSSION Our data show that the clinical effect of pallidal DBS on CD displays an exponential decay over anatomical distance from an optimised target localisation within a subregion of the internal pallidum. The results will allow a comparison of future DBS studies with postoperative MRI by verifying optimised (for instance pallidal) targeting in DBS-treated patients.
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Affiliation(s)
- Thomas Schönecker
- Department of Neurology, Charité, University Medicine Berlin, Germany Klinikum Bremeraven, Germany
| | - Doreen Gruber
- Department of Neurology, Charité, University Medicine Berlin, Germany Movement Disorder Clinic Beelitz Heilstätten, Germany
| | - Anatol Kivi
- Department of Neurology, Charité, University Medicine Berlin, Germany Department of Neurology, Vivantes Clinic Berlin Spandau, Germany
| | - Bianca Müller
- Department of Neurology, Charité, University Medicine Berlin, Germany Department of Neurology, Vivantes Clinic Berlin Spandau, Germany
| | - Elmar Lobsien
- Department of Neurology, Charité, University Medicine Berlin, Germany Department of Neurology, Helios Clinic, Erfurt, Germany
| | | | - Andrea A Kühn
- Department of Neurology, Charité, University Medicine Berlin, Germany
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University of Leipzig, Germany Department of Neuroradiology, Charité, University Medicine, Berlin, Germany
| | - Andreas R Kupsch
- Department of Neurology, Charité, University Medicine Berlin, Germany Departments of Neurology and Stereotactic Neurosurgery, Magdeburg, Germany
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49
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Aschermann Z, Perlaki G, Orsi G, Nagy SA, Horvath A, Bone B, Bihari K, Acs P, Janszky J, Komoly S, Bogner P. Quantitative assessment of brain iron by R2* relaxometry in patients with cervical dystonia. Mov Disord 2015; 30:1422-6. [PMID: 26230515 DOI: 10.1002/mds.26306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/18/2015] [Accepted: 05/25/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The pathophysiology of cervical dystonia is poorly understood. Increased brain iron deposition has been described in different movement disorders. Our aim was to investigate brain iron content in patients with cervical dystonia, using R2* relaxation rate, a validated MRI marker of brain iron level. METHODS Twelve female patients with primary focal cervical dystonia (mean age: 45.4 ± 8.0 years) and 12 age-matched healthy female subjects (mean age: 45.0 ± 8.0 years) underwent 3T MRI to obtain regional R2* relaxation rates of the thalamus, caudate nucleus, putamen, and globus pallidus (GP). Regions of interest were delineated automatically on T1-weighted MRIs. RESULTS R2* values in the putamen were positively correlated with age. Patients with cervical dystonia showed elevated R2* values in the GP. CONCLUSIONS This pilot study provides the first quantitative support for increased brain iron deposition in cervical dystonia. Further studies are needed to explore the implications of this finding.
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Affiliation(s)
| | - Gabor Perlaki
- MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary.,Pecs Diagnostic Center, Pecs, Hungary
| | - Gergely Orsi
- MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary.,Pecs Diagnostic Center, Pecs, Hungary
| | - Szilvia Anett Nagy
- Pecs Diagnostic Center, Pecs, Hungary.,Department of Neurosurgery, Section of Experimental Neuroimaging and Clinical Neuroradiology, University of Pecs, Pecs, Hungary
| | - Andrea Horvath
- Pecs Diagnostic Center, Pecs, Hungary.,Department of Neurosurgery, Section of Experimental Neuroimaging and Clinical Neuroradiology, University of Pecs, Pecs, Hungary
| | - Beata Bone
- Department of Neurology, University of Pecs, Pecs, Hungary
| | - Katalin Bihari
- National Institute of Clinical Neurosciences, Budapest, Hungary.,Department of Neurology, Bacs-Kiskun County Hospital, Kecskemet, Hungary
| | - Peter Acs
- Department of Neurology, University of Pecs, Pecs, Hungary
| | - Jozsef Janszky
- Department of Neurology, University of Pecs, Pecs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
| | - Samuel Komoly
- Department of Neurology, University of Pecs, Pecs, Hungary
| | - Peter Bogner
- Pecs Diagnostic Center, Pecs, Hungary.,Department of Neurosurgery, Section of Experimental Neuroimaging and Clinical Neuroradiology, University of Pecs, Pecs, Hungary
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50
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Meoni S, Zurowski M, Lozano AM, Hodaie M, Poon YY, Fallis M, Voon V, Moro E. Long-term neuropsychiatric outcomes after pallidal stimulation in primary and secondary dystonia. Neurology 2015; 85:433-40. [PMID: 26156506 DOI: 10.1212/wnl.0000000000001811] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 04/02/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate changes in the diagnosis of Axis I psychiatric disorders in patients with primary and secondary dystonia after deep brain stimulation (DBS) of the globus pallidus internus (GPi). METHODS Structured Clinical Interviews for the DSM-IV, Axis I psychiatric disorders, were prospectively performed before and after surgery. Diagnoses were made based on DSM-IV criteria. Psychiatric disorders were grouped into 5 categories: mood, anxiety, addiction, obsessive-compulsive disorders, and psychosis. Patients could be stratified to more than one category. Rates for unchanged diagnoses, diagnoses in remission, and new-onset diagnoses after surgery for each category were calculated. RESULTS Fifty-seven patients with primary and secondary dystonia were included. Mean ± SD age at surgery and dystonia duration at time of surgery was 50.6 ± 13.8 and 19.0 ± 13.2 years, respectively. Preoperatively, 37 Axis I diagnoses were made in 25 patients, 43.8% of those presenting with at least 1 Axis I diagnosis (mostly mood and anxiety disorders). Mean ± SD duration of psychiatric follow-up was 24.4 ± 19.6 months. Overall, after surgery no significant changes (p = 0.16) were found in Axis I diagnoses (23 patients, 40.3%): 27 (73%) unchanged, 10 (27%) in complete remission, and 4 (12.9%) new-onset diagnoses. CONCLUSIONS Our results support the overall psychiatric stability of patients with primary and secondary dystonia treated with GPi DBS. However, considering the high psychiatric morbidity in the dystonia population, psychiatric assessments before and after surgery are strongly recommended. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that GPi DBS does not change Axis I psychiatric diagnoses in patients with primary and secondary dystonia.
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Affiliation(s)
- Sara Meoni
- From the Division of Neurology (S.M., E.M.), CHU of Grenoble, Joseph Fourier University, France; the Movement Disorders Center (S.M., Y.-Y.P., M.F., E.M.), Department of Psychiatry (M.Z., V.V.), and Department of Neurosurgery (A.M.L., M.H.), Toronto Western Hospital, University of Toronto, Canada; the Division of Neurology (S.M.), A.O.U.C., University of Florence, Italy; and the Department of Psychiatry (V.V.), University of Cambridge, UK
| | - Mateusz Zurowski
- From the Division of Neurology (S.M., E.M.), CHU of Grenoble, Joseph Fourier University, France; the Movement Disorders Center (S.M., Y.-Y.P., M.F., E.M.), Department of Psychiatry (M.Z., V.V.), and Department of Neurosurgery (A.M.L., M.H.), Toronto Western Hospital, University of Toronto, Canada; the Division of Neurology (S.M.), A.O.U.C., University of Florence, Italy; and the Department of Psychiatry (V.V.), University of Cambridge, UK
| | - Andres M Lozano
- From the Division of Neurology (S.M., E.M.), CHU of Grenoble, Joseph Fourier University, France; the Movement Disorders Center (S.M., Y.-Y.P., M.F., E.M.), Department of Psychiatry (M.Z., V.V.), and Department of Neurosurgery (A.M.L., M.H.), Toronto Western Hospital, University of Toronto, Canada; the Division of Neurology (S.M.), A.O.U.C., University of Florence, Italy; and the Department of Psychiatry (V.V.), University of Cambridge, UK
| | - Mojgan Hodaie
- From the Division of Neurology (S.M., E.M.), CHU of Grenoble, Joseph Fourier University, France; the Movement Disorders Center (S.M., Y.-Y.P., M.F., E.M.), Department of Psychiatry (M.Z., V.V.), and Department of Neurosurgery (A.M.L., M.H.), Toronto Western Hospital, University of Toronto, Canada; the Division of Neurology (S.M.), A.O.U.C., University of Florence, Italy; and the Department of Psychiatry (V.V.), University of Cambridge, UK
| | - Yu-Yan Poon
- From the Division of Neurology (S.M., E.M.), CHU of Grenoble, Joseph Fourier University, France; the Movement Disorders Center (S.M., Y.-Y.P., M.F., E.M.), Department of Psychiatry (M.Z., V.V.), and Department of Neurosurgery (A.M.L., M.H.), Toronto Western Hospital, University of Toronto, Canada; the Division of Neurology (S.M.), A.O.U.C., University of Florence, Italy; and the Department of Psychiatry (V.V.), University of Cambridge, UK
| | - Melanie Fallis
- From the Division of Neurology (S.M., E.M.), CHU of Grenoble, Joseph Fourier University, France; the Movement Disorders Center (S.M., Y.-Y.P., M.F., E.M.), Department of Psychiatry (M.Z., V.V.), and Department of Neurosurgery (A.M.L., M.H.), Toronto Western Hospital, University of Toronto, Canada; the Division of Neurology (S.M.), A.O.U.C., University of Florence, Italy; and the Department of Psychiatry (V.V.), University of Cambridge, UK
| | - Valerie Voon
- From the Division of Neurology (S.M., E.M.), CHU of Grenoble, Joseph Fourier University, France; the Movement Disorders Center (S.M., Y.-Y.P., M.F., E.M.), Department of Psychiatry (M.Z., V.V.), and Department of Neurosurgery (A.M.L., M.H.), Toronto Western Hospital, University of Toronto, Canada; the Division of Neurology (S.M.), A.O.U.C., University of Florence, Italy; and the Department of Psychiatry (V.V.), University of Cambridge, UK
| | - Elena Moro
- From the Division of Neurology (S.M., E.M.), CHU of Grenoble, Joseph Fourier University, France; the Movement Disorders Center (S.M., Y.-Y.P., M.F., E.M.), Department of Psychiatry (M.Z., V.V.), and Department of Neurosurgery (A.M.L., M.H.), Toronto Western Hospital, University of Toronto, Canada; the Division of Neurology (S.M.), A.O.U.C., University of Florence, Italy; and the Department of Psychiatry (V.V.), University of Cambridge, UK.
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