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Hao QP, Zheng WT, Zhang ZH, Ding H, Qin GB, Liu YZ, Tan Y, Liu Z, Liu RE. Deep brain stimulation and pallidotomy in primary Meige syndrome: a prospective cohort study. Neurol Sci 2024:10.1007/s10072-024-07752-w. [PMID: 39266808 DOI: 10.1007/s10072-024-07752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 08/26/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Primary Meige syndrome (PMS) is a rare form of dystonia, and comparative analysis of globus pallidus internal deep brain stimulation (GPi-DBS), subthalamic nucleus deep brain stimulation (STN-DBS), and pallidotomy has been lacking. This study aims to compare the efficacy, safety, and psychiatric features of GPi-DBS, STN-DBS, and pallidotomy in patients with PMS. METHODS This prospective cohort study was divided into three groups: GPi-DBS, STN-DBS, and pallidotomy. Clinical assessments, including motor and non-motor domains, were evaluated at baseline and at 1 year and 3 years after neurostimulation/surgery. RESULTS Ninety-eight patients were recruited: 46 patients received GPi-DBS, 34 received STN-DBS, and 18 underwent pallidotomy. In the GPi-DBS group, the movement score of the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) improved from a mean (SE) of 13.8 (1.0) before surgery to 5.0 (0.7) (95% CI, -10.5 to -7.1; P < 0.001) at 3 years. Similarly, in the STN-DBS group, the mean (SE) score improved from 13.2 (0.8) to 3.5 (0.5) (95% CI, -10.3 to -8.1; P < 0.001) at 3 years, and in the pallidotomy group, it improved from 14.9 (1.3) to 6.0 (1.1) (95% CI, -11.3 to -6.5; P < 0.001) at 3 years. They were comparable therapeutic approaches for PMS that can improve motor function and quality of life without non-motor side effects. CONCLUSIONS DBS and pallidotomy are safe and effective treatments for PMS, and an in-depth exploration of non-motor symptoms may be a new entry point for gaining a comprehensive understanding of the pathophysiology.
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Affiliation(s)
- Qing-Pei Hao
- Department of Neurosurgery, Peking University People's Hospital, Xizhimen South Street, Xicheng DistrictBeijing, 100044, China
| | - Wen-Tao Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zi-Hao Zhang
- Department of Neurosurgery, Peking University People's Hospital, Xizhimen South Street, Xicheng DistrictBeijing, 100044, China
| | - Hu Ding
- Department of Neurosurgery, Peking University People's Hospital, Xizhimen South Street, Xicheng DistrictBeijing, 100044, China
| | - Guang-Biao Qin
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Ye-Zu Liu
- Department of Psychology, Peking University People's Hospital, Beijing, China
| | - Yao Tan
- Clinical Research Institute, Peking University, Beijing, China
| | - Zhi Liu
- Department of Neurosurgery, Peking University People's Hospital, Xizhimen South Street, Xicheng DistrictBeijing, 100044, China.
- Functional Neurosurgery Research Center, Peking University Health Science Center, Haidian District, Xueyuan Road, BeijingBeijing, 100191, No. 38, China.
| | - Ru-En Liu
- Department of Neurosurgery, Peking University People's Hospital, Xizhimen South Street, Xicheng DistrictBeijing, 100044, China.
- Functional Neurosurgery Research Center, Peking University Health Science Center, Haidian District, Xueyuan Road, BeijingBeijing, 100191, No. 38, China.
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Lefaucheur JP, Moro E, Shirota Y, Ugawa Y, Grippe T, Chen R, Benninger DH, Jabbari B, Attaripour S, Hallett M, Paulus W. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter. Clin Neurophysiol 2024; 164:57-99. [PMID: 38852434 DOI: 10.1016/j.clinph.2024.05.007] [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: 10/17/2023] [Revised: 03/02/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
In this review, different aspects of the use of clinical neurophysiology techniques for the treatment of movement disorders are addressed. First of all, these techniques can be used to guide neuromodulation techniques or to perform therapeutic neuromodulation as such. Neuromodulation includes invasive techniques based on the surgical implantation of electrodes and a pulse generator, such as deep brain stimulation (DBS) or spinal cord stimulation (SCS) on the one hand, and non-invasive techniques aimed at modulating or even lesioning neural structures by transcranial application. Movement disorders are one of the main areas of indication for the various neuromodulation techniques. This review focuses on the following techniques: DBS, repetitive transcranial magnetic stimulation (rTMS), low-intensity transcranial electrical stimulation, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), and focused ultrasound (FUS), including high-intensity magnetic resonance-guided FUS (MRgFUS), and pulsed mode low-intensity transcranial FUS stimulation (TUS). The main clinical conditions in which neuromodulation has proven its efficacy are Parkinson's disease, dystonia, and essential tremor, mainly using DBS or MRgFUS. There is also some evidence for Tourette syndrome (DBS), Huntington's disease (DBS), cerebellar ataxia (tDCS), and axial signs (SCS) and depression (rTMS) in PD. The development of non-invasive transcranial neuromodulation techniques is limited by the short-term clinical impact of these techniques, especially rTMS, in the context of very chronic diseases. However, at-home use (tDCS) or current advances in the design of closed-loop stimulation (tACS) may open new perspectives for the application of these techniques in patients, favored by their easier use and lower rate of adverse effects compared to invasive or lesioning methods. Finally, this review summarizes the evidence for keeping the use of electromyography to optimize the identification of muscles to be treated with botulinum toxin injection, which is indicated and widely performed for the treatment of various movement disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA 4391, ENT Team, Paris-Est Créteil University, Créteil, France.
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Yuichiro Shirota
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Talyta Grippe
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanaz Attaripour
- Department of Neurology, University of California, Irvine, CA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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3
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de Souza JCC, Falcone ACM, Barbosa RMG, Soares MC, Munhoz R, Farah M, Capato T, Casagrande SCB, Cordellini MF, de Castro Micheli G, Limongi JCP, Barbosa ER, Listik C, Cury RG. Botulinum Toxin and Deep Brain Stimulation in Dystonia. Toxins (Basel) 2024; 16:282. [PMID: 38922176 PMCID: PMC11209614 DOI: 10.3390/toxins16060282] [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: 03/25/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/27/2024] Open
Abstract
Deep Brain Stimulation (DBS) is a recognized treatment for different dystonia subtypes and has been approved by the Food and Drug Administration (FDA) since 2003. The European Federation of Neurological Societies (EFNS) and the International Parkinson and Movement Disorders Society (MDS) recommend DBS for dystonia after failure of botulinum toxin (BoNT) and other oral medications for dystonia treatment. In addition, several long-term studies have demonstrated the continuous efficacy of DBS on motor and quality of life (QoL) scores. However, there are only a few reports comparing the overall impact of surgical treatment in BoNT protocols (e.g., dosage and number of selected muscles before and after surgery). This retrospective multicenter chart-review study analyzed botulinum toxin total dosage and dosage per muscle in 23 dystonic patients before and after DBS surgery. The study's primary outcome was to analyze whether there was a reduction in BoNT dosage after DBS surgery. The mean BoNT dosages difference between baseline and post-surgery was 293.4 units for 6 months, 292.6 units for 12 months, and 295.2 units at the last visit. The median total dose of BoNT in the preoperative period was 800 units (N = 23). At the last visit, the median was 700 units (p = 0.05). This represents a 12.5% reduction in BoNT median dosage. In conclusion, despite the limitations of this retrospective study, there was a significant reduction in BoNT doses after DBS surgery in patients with generalized dystonia.
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Affiliation(s)
- Julia Carvalhinho Carlos de Souza
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Ananda Carolina Moraes Falcone
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Renata Montes Garcia Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Miriam Carvalho Soares
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Renato Munhoz
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada;
| | - Marina Farah
- Cajuru University Hospital, Pontíficia Universidade Católica do Paraná, Curitiba 80050-350, Brazil;
| | - Tamine Capato
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
- Department of Neurology, Radboud University Medical Center, 6525 Nijmegen, The Netherlands
| | - Sara Carvalho Barbosa Casagrande
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | | | - Gabriel de Castro Micheli
- Department of Neurology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil;
| | - João Carlos Papaterra Limongi
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Egberto Reis Barbosa
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Clarice Listik
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (A.C.M.F.); (R.M.G.B.); (M.C.S.); (T.C.); (S.C.B.C.); (J.C.P.L.); (E.R.B.); (C.L.); (R.G.C.)
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
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Remore LG, Tolossa M, Wei W, Karnib M, Tsolaki E, Rifi Z, Bari AA. Deep Brain Stimulation of the Medial Forebrain Bundle for Treatment-Resistant Depression: A Systematic Review Focused on the Long-Term Antidepressive Effect. Neuromodulation 2024; 27:690-700. [PMID: 37115122 DOI: 10.1016/j.neurom.2023.03.011] [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: 12/18/2022] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Major depression affects millions of people worldwide and has important social and economic consequences. Since up to 30% of patients do not respond to several lines of antidepressive drugs, deep brain stimulation (DBS) has been evaluated for the management of treatment-resistant depression (TRD). The superolateral branch of the medial forebrain bundle (slMFB) appears as a "hypothesis-driven target" because of its role in the reward-seeking system, which is dysfunctional in depression. Although initial results of slMFB-DBS from open-label studies were promising and characterized by a rapid clinical response, long-term outcomes of neurostimulation for TRD deserve particular attention. Therefore, we performed a systematic review focused on the long-term outcome of slMFB-DBS. MATERIALS AND METHODS A literature search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria was conducted to identify all studies reporting changes in depression scores after one-year follow-up and beyond. Patient, disease, surgical, and outcome data were extracted for statistical analysis. The Montgomery-Åsberg Depression Rating Scale (ΔMADRS) was used as the clinical outcome, defined as percentage reduction from baseline to follow-up evaluation. Responders' and remitters' rates were also calculated. RESULTS From 56 studies screened for review, six studies comprising 34 patients met the inclusion criteria and were analyzed. After one year of active stimulation, ΔMADRS was 60.7% ± 4%; responders' and remitters' rates were 83.8% and 61.5%, respectively. At the last follow-up, four to five years after the implantation, ΔMADRS reached 74.7% ± 4.6%. The most common side effects were stimulation related and reversible with parameter adjustments. CONCLUSIONS slMFB-DBS appears to have a strong antidepressive effect that increases over the years. Nevertheless, to date, the overall number of patients receiving implantations is limited, and the slMFB-DBS surgical technique seems to have an important impact on the clinical outcome. Further multicentric studies in a larger population are needed to confirm slMFB-DBS clinical outcomes.
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Affiliation(s)
- Luigi Gianmaria Remore
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA; University of Milan "La Statale," Milan, Italy.
| | - Meskerem Tolossa
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Wexin Wei
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Evangelia Tsolaki
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Ziad Rifi
- University of California Los Angeles, Los Angeles, CA, USA
| | - Ausaf Ahmad Bari
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Ikezawa J, Yokochi F, Okiyama R, Isoo A, Agari T, Kamiyama T, Yugeta A, Tojima M, Kawasaki T, Watanabe K, Kumada S, Takahashi K. Pallidal deep brain stimulation for patients with myoclonus-dystonia without SGCE mutations. J Neurol 2024; 271:2948-2954. [PMID: 38575756 DOI: 10.1007/s00415-024-12334-z] [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: 01/28/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Pallidal deep brain stimulation (GPi-DBS) is effective for treating myoclonus and dystonia caused by SGCE mutations (DYT-SGCE, DYT11). However, it is unknown whether GPi-DBS is effective for the treatment of myoclonus-dystonia which is not associated with the SGCE gene mutations. In this study, we investigated the efficacy of GPi-DBS in treating myoclonus-dystonia in SGCE mutation-negative cases. METHODS Three patients with myoclonus-dystonia without SGCE mutations who underwent GPi-DBS were evaluated preoperatively and 6 months postoperatively using the Unified Myoclonus Rating Scale (UMRS) and Fahn-Marsden Dystonia Rating Scale (FMDRS) for myoclonus and dystonia, respectively. In two of the three patients, myoclonus was more evident during action. Myoclonus was predominant at rest in the other patient, and he was unaware of his dystonia symptoms. The results were compared with those of the four DYT-SGCE cases. RESULTS The mean UMRS score in patients with myoclonus-dystonia without SGCE mutations improved from 61.7 to 33.7 pre- and postoperatively, respectively, and the mean FMDRS score improved from 7.2 to 4.5. However, the degree of improvement in myoclonus-dystonia in patients without SGCE mutations was inferior to that in patients with DYT-SGCE (the UMRS score improved by 45% and 69%, respectively). CONCLUSIONS GPi-DBS is effective for treating myoclonus-dystonia in patients with and without SGCE mutations. GPi-DBS should be considered as a treatment option for myoclonus-dystonia without SGCE mutations.
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Affiliation(s)
- Jun Ikezawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, Japan.
| | - Fusako Yokochi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, Japan
| | - Ryoichi Okiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, Japan
- Department of Neurology, Prime Clinic, Tokyo, Japan
| | - Ayako Isoo
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Takashi Agari
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
- Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Tsutomu Kamiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, Japan
- Department of Neurology, Symphony Clinic in Utsunomiya, Tochigi, Japan
| | - Akihiro Yugeta
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, Japan
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Maya Tojima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, Japan
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Kawasaki
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
- Department of Neurosurgery, Yokohama City University Medical Center, Kanagawa, Japan
| | - Katsushige Watanabe
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
- Department of Neurosurgery, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Satoko Kumada
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, Japan
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6
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Liu B, Mao Z, Yan X, Yang H, Xu J, Feng Z, Zhang Y, Yu X. Structural network topologies are associated with deep brain stimulation outcomes in Meige syndrome. Neurotherapeutics 2024; 21:e00367. [PMID: 38679556 DOI: 10.1016/j.neurot.2024.e00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024] Open
Abstract
Deep brain stimulation (DBS) is an effective therapy for Meige syndrome (MS). However, the DBS efficacy varies across MS patients and the factors contributing to the variable responses remain enigmatic. We aim to explain the difference in DBS efficacy from a network perspective. We collected preoperative T1-weighted MRI images of 76 MS patients who received DBS in our center. According to the symptomatic improvement rates, all MS patients were divided into two groups: the high improvement group (HIG) and the low improvement group (LIG). We constructed group-level structural covariance networks in each group and compared the graph-based topological properties and interregional connections between groups. Subsequent functional annotation and correlation analyses were also conducted. The results indicated that HIG showed a higher clustering coefficient, longer characteristic path length, lower small-world index, and lower global efficiency compared with LIG. Different nodal betweennesses and degrees between groups were mainly identified in the precuneus, sensorimotor cortex, and subcortical nuclei, among which the gray matter volume of the left precentral gyrus and left thalamus were positively correlated with the symptomatic improvement rates. Moreover, HIG had enhanced interregional connections within the somatomotor network and between the somatomotor network and default-mode network relative to LIG. We concluded that the high and low DBS responders have notable differences in large-scale network architectures. Our study sheds light on the structural network underpinnings of varying DBS responses in MS patients.
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Affiliation(s)
- Bin Liu
- Medical School of Chinese PLA, Beijing, 100853, China; Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xinyuan Yan
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Hang Yang
- Chinese Institute for Brain Research, Beijing, 102206, China
| | - Junpeng Xu
- Medical School of Chinese PLA, Beijing, 100853, China; Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhebin Feng
- Medical School of Chinese PLA, Beijing, 100853, China; Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yanyang Zhang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Xinguang Yu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
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7
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Fu S, Yang Z, He X, Liu D, Yang Z, Zhang J, Du L. Long-term Efficacy of Bilateral Globus Pallidus Stimulation in the Treatment of Meige Syndrome. Neuromodulation 2024:S1094-7159(24)00058-8. [PMID: 38597859 DOI: 10.1016/j.neurom.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/12/2024] [Accepted: 02/14/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study aimed to investigate the long-term efficacy and prognosis of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) in patients with benign essential blepharospasm (BEB) and complete Meige syndrome, and to search for the best therapeutic subregion within the GPi. MATERIALS AND METHODS Data were collected for 36 patients with Meige syndrome who underwent bilateral GPi-DBS surgery at our hospital between March 2014 and February 2022. Using the Burk-Fahn-Marsden Dystonia Rating Scale (BFMDRS)-Movement (BFMDRS-M) and BFMDRS-Disability (BFMDRS-D), the severity of the symptoms of patients with complete Meige syndrome was evaluated before surgery and at specific time points after surgery. Patients with BEB were clinically evaluated for the severity of blepharospasm using BFMDRS-M, the Blepharospasm Disability Index (BDI), and Jankovic Rating Scale (JRS). Three-dimensional reconstruction of the GPi-electrode was performed in some patients using the lead-DBS software, and the correlation between GPi subregion volume of tissue activated (VTA) and symptom improvement was analyzed in patients six months after surgery. The follow-up duration ranged from six to 99 months. RESULTS Compared with preoperative scores, the results of all patients at six months after surgery and final follow-up showed a significant decrease (p < 0.05) in the mean BFMDRS-M score. Among them, the average BFMDRS-M improvement rates in patients with BEB at six months after surgery and final follow-up were 60.3% and 69.7%, respectively, whereas those in patients with complete Meige syndrome were 54.5% and 58.3%, respectively. The average JRS and BDI scores of patients with BEB also decreased significantly (p < 0.05) at six months after surgery and at the final follow-up (JRS improvement: 38.6% and 49.1%, respectively; BDI improvement: 42.6% and 57.4%, respectively). We were unable to identify significantly correlated prognostic factors. There was a significant correlation between GPi occipital VTA and symptom improvement in patients at six months after surgery (r = 0.34, p = 0.025). CONCLUSIONS Our study suggests that bilateral GPi-DBS is an effective treatment for Meige syndrome, with no serious postoperative complications. The VTA in the GPi subregion may be related to the movement score improvement. In addition, further research is needed to predict patients with poor surgical outcomes.
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8
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Samanci B, Şahin E, Samanci Y, Bilgiç B, Atasu B, Lohmann E, Peker S, Hanağası HA. Pallidal Deep Brain Stimulation Improves HPCA-Linked (DYT 2) Dystonia. Mov Disord Clin Pract 2024; 11:184-187. [PMID: 38386491 PMCID: PMC10883396 DOI: 10.1002/mdc3.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 02/24/2024] Open
Affiliation(s)
- Bedia Samanci
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Erdi Şahin
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University Faculty of MedicineKoc UniversityIstanbulTurkey
| | - Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Burcu Atasu
- German Center for Neurodegenerative Diseases (DZNE)‐TübingenTübingenGermany
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Ebba Lohmann
- German Center for Neurodegenerative Diseases (DZNE)‐TübingenTübingenGermany
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Selçuk Peker
- Department of Neurosurgery, Koc University Faculty of MedicineKoc UniversityIstanbulTurkey
| | - Haşmet A. Hanağası
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
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9
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Cuartero MC, Grabli D, Flamand-Roze E, Karachi C, Rouaud T, Derkinderen P, Damier P, Raoul S, Krack P, Moro E, Fraix V, Chabardès S, Burbaud P, Guehl D, Cuny E, Pinto S, Vidailhet M. Lessons from multitarget neurostimulation in isolated dystonia: Less is more? Brain Stimul 2024; 17:104-106. [PMID: 38182095 DOI: 10.1016/j.brs.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Marie-Charlotte Cuartero
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière (ICM), Centre d'Investigation Clinique (CIC) 1422, Paris, France; Aix-Marseille Univ, CNRS, LPL, Aix-en-Provence, France.
| | - David Grabli
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière (ICM), Centre d'Investigation Clinique (CIC) 1422, Paris, France
| | - Emmanuel Flamand-Roze
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière (ICM), Centre d'Investigation Clinique (CIC) 1422, Paris, France
| | - Carine Karachi
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière (ICM), Centre d'Investigation Clinique (CIC) 1422, Paris, France
| | - Tiphaine Rouaud
- Department of Neurology, Nantes Université, CHU Nantes, INSERM, Nantes, France
| | - Pascal Derkinderen
- Department of Neurology, Nantes Université, CHU Nantes, INSERM, Nantes, France
| | - Philippe Damier
- Department of Neurology, Nantes Université, CHU Nantes, INSERM, Nantes, France
| | - Sylvie Raoul
- Department of Neurosurgery, Nantes Université, CHU Nantes, INSERM, Nantes, France
| | - Paul Krack
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Elena Moro
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Neurology Department, Grenoble, France
| | - Valérie Fraix
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Neurology Department, Grenoble, France
| | - Stéphan Chabardès
- Univ. Grenoble Alpes, CEA, LETI, Clinatec, Department Neurosurgery, Grenoble, France
| | - Pierre Burbaud
- Department of Clinical Neurosciences, CHU Bordeaux & IMN CNRS UMR 5293, CNRS, University of Bordeaux, Bordeaux, France
| | - Dominique Guehl
- Department of Clinical Neurosciences, CHU Bordeaux & IMN CNRS UMR 5293, CNRS, University of Bordeaux, Bordeaux, France
| | - Emmanuel Cuny
- Department of Neurosurgery, CHU Bordeaux & IMN CNRS UMR 5293, CNRS, University of Bordeaux, Bordeaux, France
| | - Serge Pinto
- Aix-Marseille Univ, CNRS, LPL, Aix-en-Provence, France
| | - Marie Vidailhet
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière (ICM), Centre d'Investigation Clinique (CIC) 1422, Paris, France.
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10
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Rački V, Hero M, Papić E, Rožmarić G, Čizmarević NS, Chudy D, Peterlin B, Vuletić V. Applicability of clinical genetic testing for deep brain stimulation treatment in monogenic Parkinson's disease and monogenic dystonia: a multidisciplinary team perspective. Front Neurosci 2023; 17:1282267. [PMID: 38027472 PMCID: PMC10667448 DOI: 10.3389/fnins.2023.1282267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
In this perspective article, we highlight the possible applicability of genetic testing in Parkinson's disease and dystonia patients treated with deep brain stimulation (DBS). DBS, a neuromodulatory technique employing electrical stimulation, has historically targeted motor symptoms in advanced PD and dystonia, yet its precise mechanisms remain elusive. Genetic insights have emerged as potential determinants of DBS efficacy. Known PD genes such as GBA, SNCA, LRRK2, and PRKN are most studied, even though further studies are required to make firm conclusions. Variable outcomes depending on genotype is present in genetic dystonia, as DYT-TOR1A, NBIA/DYTPANK2, DYT-SCGE and X-linked dystonia-parkinsonism have demonstrated promising outcomes following GPi-DBS, while varying outcomes have been documented in DYT-THAP1. We present two clinical vignettes that illustrate the applicability of genetics in clinical practice, with one PD patient with compound GBA mutations and one GNAL dystonia patient. Integrating genetic testing into clinical practice is pivotal, particularly with advancements in next-generation sequencing. However, there is a clear need for further research, especially in rarer monogenic forms. Our perspective is that applying genetics in PD and dystonia is possible today, and despite challenges, it has the potential to refine patient selection and enhance treatment outcomes.
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Affiliation(s)
- Valentino Rački
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mario Hero
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Eliša Papić
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Gloria Rožmarić
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Nada Starčević Čizmarević
- Department of Medical Genomics and Biology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Darko Chudy
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Borut Peterlin
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vladimira Vuletić
- Department of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia
- Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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11
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Hao Q, Lv G, Zheng W, Zhang Z, Ding H, OuYang J, Wu G, Xiang F, Tan Y, Wu G, Liu R. Comparison of GPi-DBS, STN-DBS, and pallidotomy in primary Meige syndrome. Brain Stimul 2023; 16:1450-1451. [PMID: 37774913 DOI: 10.1016/j.brs.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023] Open
Affiliation(s)
- Qingpei Hao
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Gaoquan Lv
- Department of Neuroradiology, Peking University People's Hospital, Beijing, China
| | - Wentao Zheng
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Zihao Zhang
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Hu Ding
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Jia OuYang
- Functional Neurosurgery Research Center, Peking University Health Science Center, Beijing, China
| | - Gang Wu
- Department of Psychology, Peking University People's Hospital, Beijing, China
| | - Fanding Xiang
- Statistics Center, Beijing University of Technology, Beijing, China
| | - Yao Tan
- Clinical Research Institute, Peking University, Beijing, China
| | - Guangyong Wu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China; Functional Neurosurgery Research Center, Peking University Health Science Center, Beijing, China; Department of Neurosurgery, Beijing Shunyi Hospital, Beijing, China.
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China; Functional Neurosurgery Research Center, Peking University Health Science Center, Beijing, China.
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12
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Marie V. What have we learned about the biology of dystonia from deep brain stimulation? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:481-491. [PMID: 37482401 DOI: 10.1016/bs.irn.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Deep brain stimulation has dramatically changed the management of patients with dystonia, therapeutic approach of dystonia with marked improvement of dystonia and functional disability. However, despite decades of experience and identification of good prognosis factors, prediction of beneficial effect at the individual level is still a challenge. There is inter-individual variability in therapeutic outcome. Genetic factors are identified but subgroups of patients still have relapse or worsening of dystonia in short or long term. Possible "biological factors" underlying such a difference among patients are discussed, including structural or functional differences including altered plasticity.
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Affiliation(s)
- Vidailhet Marie
- Sorbonne Université, Paris Brain Institute - ICM, Inserm CNRS, Paris, France; Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Neurology, Paris, France.
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13
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Del Vecchio Del Vecchio J, Hanafi I, Pozzi NG, Capetian P, Isaias IU, Haufe S, Palmisano C. Pallidal Recordings in Chronically Implanted Dystonic Patients: Mitigation of Tremor-Related Artifacts. Bioengineering (Basel) 2023; 10:bioengineering10040476. [PMID: 37106663 PMCID: PMC10135680 DOI: 10.3390/bioengineering10040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023] Open
Abstract
Low-frequency oscillatory patterns of pallidal local field potentials (LFPs) have been proposed as a physiomarker for dystonia and hold the promise for personalized adaptive deep brain stimulation. Head tremor, a low-frequency involuntary rhythmic movement typical of cervical dystonia, may cause movement artifacts in LFP signals, compromising the reliability of low-frequency oscillations as biomarkers for adaptive neurostimulation. We investigated chronic pallidal LFPs with the PerceptTM PC (Medtronic PLC) device in eight subjects with dystonia (five with head tremors). We applied a multiple regression approach to pallidal LFPs in patients with head tremors using kinematic information measured with an inertial measurement unit (IMU) and an electromyographic signal (EMG). With IMU regression, we found tremor contamination in all subjects, whereas EMG regression identified it in only three out of five. IMU regression was also superior to EMG regression in removing tremor-related artifacts and resulted in a significant power reduction, especially in the theta-alpha band. Pallido-muscular coherence was affected by a head tremor and disappeared after IMU regression. Our results show that the Percept PC can record low-frequency oscillations but also reveal spectral contamination due to movement artifacts. IMU regression can identify such artifact contamination and be a suitable tool for its removal.
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Affiliation(s)
- Jasmin Del Vecchio Del Vecchio
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany
| | - Nicoló Gabriele Pozzi
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany
| | - Philipp Capetian
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany
| | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany
- Centro Parkinson e Parkinsonismi, ASST G. Pini-CTO, 20122 Milano, Italy
| | - Stefan Haufe
- Uncertainty, Inverse Modeling and Machine Learning Group, Technische Universität Berlin, 10623 Berlin, Germany
- Physikalisch-Technische Bundesanstalt Braunschweig und Berlin, 10587 Berlin, Germany
- Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius-Maximilian-University Würzburg, 97080 Würzburg, Germany
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14
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Wang X, Mao Z, Yu X. Volume of tissue activated within subthalamic nucleus and clinical efficacy of deep brain stimulation in Meige syndrome. Neurol Sci 2023; 44:1643-1651. [PMID: 36622476 DOI: 10.1007/s10072-022-06594-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The clinical efficacy of deep brain stimulation (DBS) relies on the optimal electrode placement in a large extent. Subthalamic nucleus (STN) DBS was recognized as clinically effective for Meige syndrome. This study identified the correlations of volume of tissue activated (VTA) within the motor STN and the final efficacy of the surgical procedure. METHODS Clinical outcomes of the patients (n=25) were evaluated with the percentage improvement in Burke-Fahn-Marsden Dystonia Rating Scale movement (BFMDRS-M) scores at the last follow-up (LFU) visit. Pearson's correlation coefficients were calculated to identify the relationship of the final clinical outcomes with the VTA within the STN, VTA within the different STN territories, and other clinical variables. RESULTS On the whole, the patients showed an average of 59.21% improvement at the LFU visit relative to the baseline (5.72 ± 7.31 vs. 13.70 ± 7.36, P ˂ 0.001). Active electrode contacts mainly clustered in the STN motor territories. There were significant positive correlations between the BFMDRS-M percentage improvement and VTA within the STN (Pearson r = 0.434, P = 0.039) and the STN motor territories (r = 0.430, P = 0.041), but not associative or limbic STN. Other basic clinical characteristics including age, disease duration, and preoperative scores were not significantly correlated with the final outcomes. CONCLUSIONS Our study further validated the efficacy of STN-DBS in even the cases with intractable Meige syndrome. Furthermore, VTA within the motor STN could serve as a potential prognostic factor for the final clinical outcomes.
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Affiliation(s)
- Xin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, Shandong, China.
| | - Zhiqi Mao
- 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
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15
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Neurophysiological Basis of Deep Brain Stimulation and Botulinum Neurotoxin Injection for Treating Oromandibular Dystonia. Toxins (Basel) 2022; 14:toxins14110751. [PMID: 36356002 PMCID: PMC9694803 DOI: 10.3390/toxins14110751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Oromandibular dystonia (OMD) induces severe motor impairments, such as masticatory disturbances, dysphagia, and dysarthria, resulting in a serious decline in quality of life. Non-invasive brain-imaging techniques such as electroencephalography (EEG) and magnetoencephalography (MEG) are powerful approaches that can elucidate human cortical activity with high temporal resolution. Previous studies with EEG and MEG have revealed that movements in the stomatognathic system are regulated by the bilateral central cortex. Recently, in addition to the standard therapy of botulinum neurotoxin (BoNT) injection into the affected muscles, bilateral deep brain stimulation (DBS) has been applied for the treatment of OMD. However, some patients' OMD symptoms do not improve sufficiently after DBS, and they require additional BoNT therapy. In this review, we provide an overview of the unique central spatiotemporal processing mechanisms in these regions in the bilateral cortex using EEG and MEG, as they relate to the sensorimotor functions of the stomatognathic system. Increased knowledge regarding the neurophysiological underpinnings of the stomatognathic system will improve our understanding of OMD and other movement disorders, as well as aid the development of potential novel approaches such as combination treatment with BoNT injection and DBS or non-invasive cortical current stimulation therapies.
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16
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Santifort KM, Mandigers PJJ. Dystonia in veterinary neurology. J Vet Intern Med 2022; 36:1872-1881. [PMID: 36086931 DOI: 10.1111/jvim.16532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/22/2022] [Indexed: 11/27/2022] Open
Abstract
Dystonia is a clinical sign and main feature of many movement disorders in humans as well as veterinary species. It is characterized by sustained or intermittent involuntary muscle contractions causing abnormal (often repetitive) movements, postures, or both. This review discusses the terminology and definition of dystonia, its phenomenology, and its pathophysiology, and provides considerations regarding the diagnosis and treatment of dystonia in dogs and cats. In addition, currently recognized or reported disorders in dogs and cats in which dystonia is a particular or main feature are discussed and comparisons are made between disorders featuring dystonia in humans and animals. We suggest that when describing the phenomenology of dogs and cats with dystonia, if possible the following should be included: activity being performed at onset (e.g., resting or running or exercise-induced), body distribution, duration, responsiveness (subjective), severity, temporal pattern (i.e., paroxysmal or persistent, severity at onset and at later stages), presence or absence of autonomic signs (e.g., salivation), presence or absence of preceding signs (e.g., restlessness), presence or absence of signs after dystonia subsides (e.g., sleepiness), coexistence of other movement disorders, any other neurological manifestations, and possible links to administered medications, intoxications or other associated factors. We also suggest that dystonia be classified based on its etiology as either structural genetic, suspected genetic, reactive, or unknown.
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Affiliation(s)
| | - Paul J J Mandigers
- Evidensia Referral Hospitals, Arnhem, The Netherlands.,Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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