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Deep Brain Stimulation in the Treatment of Tardive Dyskinesia. J Clin Med 2023; 12:jcm12051868. [PMID: 36902655 PMCID: PMC10003252 DOI: 10.3390/jcm12051868] [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: 11/09/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Tardive dyskinesia (TD) is a phenomenon observed following the predominantly long-term use of dopamine receptor blockers (antipsychotics) widely used in psychiatry. TD is a group of involuntary, irregular hyperkinetic movements, mainly in the muscles of the face, eyelid, lips, tongue, and cheeks, and less frequently in the limbs, neck, pelvis, and trunk. In some patients, TD takes on an extremely severe form, massively disrupting functioning and, moreover, causing stigmatization and suffering. Deep brain stimulation (DBS), a method used, among others, in Parkinson's disease, is also an effective treatment for TD and often becomes a method of last resort, especially in severe, drug-resistant forms. The group of TD patients who have undergone DBS is still very limited. The procedure is relatively new in TD, so the available reliable clinical studies are few and consist mainly of case reports. Unilateral and bilateral stimulation of two sites has proven efficacy in TD treatment. Most authors describe stimulation of the globus pallidus internus (GPi); less frequent descriptions involve the subthalamic nucleus (STN). In the present paper, we provide up-to-date information on the stimulation of both mentioned brain areas. We also compare the efficacy of the two methods by comparing the two available studies that included the largest groups of patients. Although GPi stimulation is more frequently described in literature, our analysis indicates comparable results (reduction of involuntary movements) with STN DBS.
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Zheng W, Lv G, Lu Y, Liu J, Hao Q, Ding H, Liu Y, Liu R. Bilateral Pallidal Deep Brain Stimulation in Meige Syndrome: Effects on Motor Function, Neuropsychological Status, and Mood. Neurosurgery 2023; 92:1073-1079. [PMID: 36728352 DOI: 10.1227/neu.0000000000002335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/01/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Bilateral pallidal deep brain stimulation (DBS) has been broadly accepted as a feasible surgical procedure for treating various forms of dystonia, but its effects on motor function, neuropsychological status, and mood in patients with Meige syndrome have rarely been examined. OBJECTIVE To evaluate the effects of bilateral globus pallidus internus DBS (GPi-DBS) on the motor performance, quality of life, neuropsychological status, and mood of patients with primary Meige syndrome. METHODS Between January 2015 and April 2019, the database of 35 patients with Meige syndrome who underwent bilateral GPi-DBS in our institution was retrospectively reviewed. The severity of dystonia, health-related quality of life, cognitive function, and mood were assessed using standardized and validated rating scales at baseline. Repeat assessment of the same domains was performed at 1 year and 3 years after neurostimulation in a similar manner. RESULTS One year and 3 years after bilateral GPi-DBS, Burke-Fahn-Marsden Dystonia Rating Scale movement scores were improved by 65% and 72% and Burke-Fahn-Marsden Dystonia Rating Scale disability scores were improved by 49% and 57%, respectively. The significant improvement in health-related quality of life observed at 1 year was sustained at 3 years. Relative to baseline and to the 1-year assessment, cognitive functions and mood remained stable after 3 years of neurostimulation. No deaths or life-threatening events were reported over the study period. CONCLUSION Bilateral GPi-DBS is a safe and effective approach for medically refractory Meige syndrome that can improve motor function and quality of life without cognitive and mood side effects.
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Affiliation(s)
- Wentao Zheng
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Gaoquan Lv
- Departments of Neurology and Radiology, Peking University People's Hospital, Beijing, China
| | - Yunwei Lu
- Department of Intensive Care Medicine, Trauma Center, Peking University People's Hospital, Beijing, China
| | - Jiayu Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Qingpei Hao
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Hu Ding
- Functional Neurosurgery Research Center, Peking University Health Science Center, Beijing, China
| | - Yezu Liu
- Departments of Neurology and Radiology, Peking University People's Hospital, Beijing, China
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
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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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Mulroy E, Vijiaratnam N, De Roquemaurel A, Bhatia KP, Zrinzo L, Foltynie T, Limousin P. A practical guide to troubleshooting pallidal deep brain stimulation issues in patients with dystonia. Parkinsonism Relat Disord 2021; 87:142-154. [PMID: 34074583 DOI: 10.1016/j.parkreldis.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/18/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
High frequency deep brain stimulation (DBS) of the internal portion of the globus pallidus has, in the last two decades, become a mainstream therapy for the management of medically-refractory dystonia syndromes. Such increasing uptake places an onus on movement disorder physicians to become familiar with this treatment modality, in particular optimal patient selection for the procedure and how to troubleshoot problems relating to sub-optimal efficacy and therapy-related side effects. Deep brain stimulation for dystonic conditions presents some unique challenges. For example, the frequent lack of immediate change in clinical status following stimulation alterations means that programming often relies on personal experience and local practice rather than real-time indicators of efficacy. Further, dystonia is a highly heterogeneous disorder, making the development of unifying guidelines and programming algorithms for DBS in this population difficult. Consequently, physicians may feel less confident in managing DBS for dystonia as compared to other indications e.g. Parkinson's disease. In this review, we integrate our years of personal experience of the programming of DBS systems for dystonia with a critical appraisal of the literature to produce a practical guide for troubleshooting common issues encountered in patients with dystonia treated with DBS, in the hope of improving the care for these patients.
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Affiliation(s)
- Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK.
| | - Nirosen Vijiaratnam
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Alexis De Roquemaurel
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
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Listik C, Listik E, Cury RG, Barbosa ER, Teixeira MJ, Andrade DCD. Deep brain stimulation treatment in dystonia: a bibliometric analysis. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:586-592. [PMID: 33053012 DOI: 10.1590/0004-282x20200016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/27/2020] [Indexed: 08/11/2023]
Abstract
BACKGROUND Dystonia is a heterogeneous disorder that, when refractory to medical treatment, may have a favorable response to deep brain stimulation (DBS). A practical way to have an overview of a research domain is through a bibliometric analysis, as it makes it more accessible for researchers and others outside the field to have an idea of its directions and needs. OBJECTIVE To analyze the 100 most cited articles in the use of DBS for dystonia treatment in the last 30 years. METHODS The research protocol was performed in June 2019 in Elsevier's Scopus database, by retrieving the most cited articles regarding DBS in dystonia. We analyzed authors, year of publication, country, affiliation, and targets of DBS. RESULTS Articles are mainly published in Movement Disorders (19%), Journal of Neurosurgery (9%), and Neurology (9%). European countries offer significant contributions (57% of our sample). France (192.5 citations/paper) and Germany (144.1 citations/paper) have the highest citation rates of all countries. The United States contributes with 31% of the articles, with 129.8 citations/paper. The publications are focused on General outcomes (46%), followed by Long-term outcomes (12.5%), and Complications (11%), and the leading type of dystonia researched is idiopathic or inherited, isolated, segmental or generalized dystonia, with 27% of articles and 204.3 citations/paper. CONCLUSIONS DBS in dystonia research is mainly published in a handful of scientific journals and focused on the outcomes of the surgery in idiopathic or inherited, isolated, segmental or generalized dystonia, and with globus pallidus internus as the main DBS target.
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Affiliation(s)
- Clarice Listik
- Universidade de São Paulo, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
| | - Eduardo Listik
- Universidade Federal de São Paulo, Departamento de Bioquímica, São Paulo SP, Brazil
| | - Rubens Gisbert Cury
- Universidade de São Paulo, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil
| | | | - Daniel Ciampi de Andrade
- Universidade de São Paulo, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.,Instituto do Câncer do Estado de São Paulo, Centro de Dor, São Paulo SP, Brazil
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Muñoz KA, Blumenthal-Barby J, Storch EA, Torgerson L, Lázaro-Muñoz G. Pediatric Deep Brain Stimulation for Dystonia: Current State and Ethical Considerations. Camb Q Healthc Ethics 2020; 29:557-573. [PMID: 32892777 PMCID: PMC9426302 DOI: 10.1017/s0963180120000316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Dystonia is a movement disorder that can have a debilitating impact on motor functions and quality of life. There are 250,000 cases in the United States, most with childhood onset. Due to the limited effectiveness and side effects of available treatments, pediatric deep brain stimulation (pDBS) has emerged as an intervention for refractory dystonia. However, there is limited clinical and neuroethics research in this area of clinical practice. This paper examines whether it is ethically justified to offer pDBS to children with refractory dystonia. Given the favorable risk-benefit profile, it is concluded that offering pDBS is ethically justified for certain etiologies of dystonia, but it is less clear for others. In addition, various ethical and policy concerns are discussed, which need to be addressed to optimize the practice of offering pDBS for dystonia. Strategies are proposed to help address these concerns as pDBS continues to expand.
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Affiliation(s)
- Katrina A. Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | | | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
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Jiang H, Wang R, Zheng Z, Zhu J. Deep brain stimulation for the treatment of cerebral palsy: A review. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2020.9050002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Deep brain stimulation (DBS) has been used as a safe and effective neuromodulation technique for treatment of various diseases. A large number of patients suffering from movement disorders such as dyskinesia may benefit from DBS. Cerebral palsy (CP) is a group of permanent disorders mainly involving motor impairment, and medical interventions are usually unsatisfactory or temporarily active, especially for dyskinetic CP. DBS may be another approach to the treatment of CP. In this review we discuss the targets for DBS and the mechanisms of action for the treatment of CP, and focus on presurgical assessment, efficacy for dystonia and other symptoms, safety, and risks.
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Affiliation(s)
- Hongjie Jiang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Rui Wang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhe Zheng
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Junming Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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Krause P, Völzmann S, Ewert S, Kupsch A, Schneider GH, Kühn AA. Long-term effects of bilateral pallidal deep brain stimulation in dystonia: a follow-up between 8 and 16 years. J Neurol 2020; 267:1622-1631. [PMID: 32055996 PMCID: PMC8592956 DOI: 10.1007/s00415-020-09745-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
Objective Observational study to evaluate the long-term motor and non-motor effects of deep brain stimulation (DBS) of the globus pallidus internus (GPi) on medically refractory dystonia. Background Dystonia is a chronic disease affecting mainly young patients with a regular life expectancy and lifelong need for therapy. Pallidal DBS is an established treatment for severe isolated dystonia but long-term data are sparse. Methods We considered 36 consecutive patients with isolated generalized (n = 14) and cervical/segmental (n = 22) dystonia operated at Charité-University Hospital between 2000 and 2007 in a retrospective analysis for long-term outcome of pallidal DBS. In 19 of these patients, we could analyze dystonic symptoms and disability rated by the Burke–Fahn–Marsden Dystonia Rating scale (BFMDRS) at baseline, short-term (ST-FU, range 3–36 months) and long-term follow-up (LT-FU, range 93–197 months). Quality of life and mood were evaluated using the SF36 and Beck Depression Index (BDI) questionnaires. Results Patients reached an improvement in motor symptoms of 63.8 ± 5.7% (mean ± SE) at ST-FU and 67.9 ± 6.1% at LT-FU. Moreover, a significant and stable reduction in disability was shown following DBS (54.2 ± 9.4% at ST-FU and 53.8 ± 9.2% at LT-FU). BDI and SF36 had improved by 40% and 23%, respectively, at LT-FU (n = 14). Stimulation-induced adverse events included swallowing difficulties, dysarthria, and bradykinesia. Pulse generator (n = 3) and electrodes (n = 5) were revised in seven patients due to infection. Conclusions Pallidal DBS is a safe and efficacious long-term treatment for dystonia with sustained effects on motor impairment and disability, accompanied by a robust improvement in mood and quality of life. Electronic supplementary material The online version of this article (10.1007/s00415-020-09745-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Krause
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - S Völzmann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - S Ewert
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - A Kupsch
- Department of Neurology and Stereotactic Neurosurgery, University Medicine of Magdeburg, Magdeburg, Germany
| | - G H Schneider
- Department of Neurosurgery, Charité, University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Pekrul M, Seer C, Lange F, Dressler D, Kopp B. Flanker Task Performance in Isolated Dystonia (Blepharospasm): A Focus on Sequential Effects. Brain Sci 2020; 10:brainsci10020076. [PMID: 32024200 PMCID: PMC7071414 DOI: 10.3390/brainsci10020076] [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: 01/13/2020] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022] Open
Abstract
Isolated dystonia manifests with involuntary muscle hyperactivity, but the extent of cognitive impairment remains controversial. We examined the executive functions in blepharospasm while accounting for motor symptom-related distractions as a factor often limiting the interpretability of neuropsychological studies in dystonia. Our control group comprised of patients with hemifacial spasm, which is a condition producing similar motor symptoms without any central nervous system pathology. Nineteen patients with blepharospasm and 22 patients with hemifacial spasm completed a flanker task. Stimulus congruency on the current trial, on the preceding trial, and a response sequence served as independent variables. We analyzed the response time and accuracy. Gross overall group differences were not discernible. While congruency, congruency sequence, and response sequence exerted the expected effects, no group differences emerged with regard to these variables. A difference between patients with blepharospasm and those with hemifacial spasm consisted in longer reaction times when responses had to be repeated following stimulus incongruency on the preceding trial. We conclude that patients with blepharospasm seem to have difficulties in repeating their responses when incongruency on preceding trials interferes with habit formation or other forms of fast routes to action. Our specific finding may provide an opportunity to study altered basal ganglia plasticity in focal dystonia.
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Affiliation(s)
- Max Pekrul
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
- Correspondence:
| | - Caroline Seer
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
- LBI—KU Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium
| | - Florian Lange
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
- Behavioral Engineering Research Group, KU Leuven, Naamsestraat 69, 3000 Leuven, Belgium
| | - Dirk Dressler
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (C.S.); (F.L.); (D.D.); (B.K.)
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Greuel A, Pauls KAM, Koy A, Südmeyer M, Schnitzler A, Timmermann L, Fink GR, Eggers C. Pallidal Deep Brain Stimulation Reduces Sensorimotor Cortex Activation in Focal/Segmental Dystonia. Mov Disord 2020; 35:629-639. [DOI: 10.1002/mds.27970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Andrea Greuel
- Department of Neurology University Hospital of Giessen and Marburg Marburg Germany
| | - K. Amande M. Pauls
- Department of Neurology Helsinki University Central Hospital Helsinki Finland
- Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
- BioMag Laboratory, Helsinki University Hospital Medical Imaging Center University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anne Koy
- Department of Pediatrics Faculty of Medicine and University Hospital Cologne, University of Cologne Cologne Germany
| | - Martin Südmeyer
- Department of Neurology Ernst‐von‐Bergmann Klinikum Potsdam Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Department of Neurology, Medical Faculty Heinrich‐Heine‐University Düsseldorf Düsseldorf Germany
| | - Lars Timmermann
- Department of Neurology University Hospital of Giessen and Marburg Marburg Germany
- Center for Mind, Brain and Behavior Universities Marburg and Giessen Marburg Germany
| | - Gereon R. Fink
- Department of Neurology Faculty of Medicine and University Hospital Cologne, University of Cologne Cologne Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM‐3) Research Center Jülich Jülich Germany
| | - Carsten Eggers
- Department of Neurology University Hospital of Giessen and Marburg Marburg Germany
- Center for Mind, Brain and Behavior Universities Marburg and Giessen Marburg Germany
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11
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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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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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Hitti FL, Vaughan KA, Ramayya AG, McShane BJ, Baltuch GH. Reduced long-term cost and increased patient satisfaction with rechargeable implantable pulse generators for deep brain stimulation. J Neurosurg 2019; 131:799-806. [PMID: 30265199 DOI: 10.3171/2018.4.jns172995] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) has revolutionized the treatment of neurological disease, but its therapeutic efficacy is limited by the lifetime of the implantable pulse generator (IPG) batteries. At the end of the battery life, IPG replacement surgery is required. New IPGs with rechargeable batteries (RC-IPGs) have recently been introduced and allow for decreased reoperation rates for IPG replacements. The authors aimed to examine the merits and limitations of these devices. METHODS The authors reviewed the medical records of patients who underwent DBS implantation at their institution. RC-IPGs were placed either during initial DBS implantation or during an IPG change. A cost analysis was performed that compared RC-IPGs with standard IPGs, and telephone patient surveys were conducted to assess patient satisfaction. RESULTS The authors identified 206 consecutive patients from 2011 to 2016 who underwent RC-IPG placement (mean age 61 years; 67 women, 33%). Parkinson's disease was the most common indication for DBS (n = 144, 70%), followed by essential tremor (n = 41, 20%), dystonia (n = 13, 6%), depression (n = 5, 2%), multiple sclerosis tremor (n = 2, 1%), and epilepsy (n = 1, 0.5%). DBS leads were typically placed bilaterally (n = 192, 93%) and targeted the subthalamic nucleus (n = 136, 66%), ventral intermediate nucleus of the thalamus (n = 43, 21%), internal globus pallidus (n = 21, 10%), ventral striatum (n = 5, 2%), or anterior nucleus of the thalamus (n = 1, 0.5%). RC-IPGs were inserted at initial DBS implantation in 123 patients (60%), while 83 patients (40%) were converted to RC-IPGs during an IPG replacement surgery. The authors found that RC-IPG implantation resulted in $60,900 of cost savings over the course of 9 years. Furthermore, patient satisfaction was high with RC-IPG implantation. Overall, 87.3% of patients who responded to the survey were satisfied with their device, and only 6.7% found the rechargeable component difficult to use. In patients who were switched from a standard IPG to RC-IPG, the majority who responded (70.3%) preferred the rechargeable IPG. CONCLUSIONS RC-IPGs can provide DBS patients with long-term therapeutic benefit while minimizing the need for battery replacement surgery. The authors have implanted rechargeable stimulators in 206 patients undergoing DBS surgery, and here they demonstrate the cost-effectiveness and high patient satisfaction associated with this procedure.
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Stavrinou LC, Liouta E, Boviatsis EJ, Leonardos A, Gatzonis S, Stathis P, Sakas DE, Angelakis E. Effect of constant-current pallidal deep brain stimulation for primary dystonia on cognition, mood and quality of life: Results from a prospective pilot trial. Clin Neurol Neurosurg 2019; 185:105460. [DOI: 10.1016/j.clineuro.2019.105460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/28/2019] [Accepted: 08/06/2019] [Indexed: 01/21/2023]
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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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Cernera S, Okun MS, Gunduz A. A Review of Cognitive Outcomes Across Movement Disorder Patients Undergoing Deep Brain Stimulation. Front Neurol 2019; 10:419. [PMID: 31133956 PMCID: PMC6514131 DOI: 10.3389/fneur.2019.00419] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/05/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: Although the benefit in motor symptoms for well-selected patients with deep brain stimulation (DBS) has been established, cognitive declines associated with DBS can produce suboptimal clinical responses. Small decrements in cognition can lead to profound effects on quality of life. The growth of indications, the expansion of surgical targets, the increasing complexity of devices, and recent changes in stimulation paradigms have all collectively drawn attention to the need for re-evaluation of DBS related cognitive outcomes. Methods: To address the impact of cognitive changes following DBS, we performed a literature review using PubMed. We searched for articles focused on DBS and cognition. We extracted information about the disease, target, number of patients, assessment of time points, cognitive battery, and clinical outcomes. Diseases included were dystonia, Tourette syndrome (TS), essential tremor (ET), and Parkinson's disease (PD). Results: DBS was associated with mild cognitive issues even when rigorous patient selection was employed. Dystonia studies reported stable or improved cognitive scores, however one study using reliable change indices indicated decrements in sustained attention. Additionally, DBS outcomes were convoluted with changes in medication dose, alleviation of motor symptoms, and learning effects. In the largest, prospective TS study, an improvement in attentional skills was noted, whereas smaller studies reported variable declines across several cognitive domains. Although, most studies reported stable cognitive outcomes. ET studies largely demonstrated deficits in verbal fluency, which had variable responses depending on stimulation setting. Recently, studies have focused beyond the ventral intermediate nucleus, including the post-subthalamic area and zona incerta. For PD, the cognitive results were heterogeneous, although deficits in verbal fluency were consistent and related to the micro-lesion effect. Conclusion: Post-DBS cognitive issues can impact both motor and quality of life outcomes. The underlying pathophysiology of cognitive changes post-DBS and the identification of pathways underpinning declines will require further investigation. Future studies should employ careful methodological designs. Patient specific analyses will be helpful to differentiate the effects of medications, DBS and the underlying disease state, including disease progression. Disease progression is often an underappreciated factor that is important to post-DBS cognitive issues.
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Affiliation(s)
- Stephanie Cernera
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, FL, United States
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States.,Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, FL, United States
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Hitti FL, Ramayya AG, McShane BJ, Yang AI, Vaughan KA, Baltuch GH. Long-term outcomes following deep brain stimulation for Parkinson's disease. J Neurosurg 2019; 132:205-210. [PMID: 30660117 DOI: 10.3171/2018.8.jns182081] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/28/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective treatment for several movement disorders, including Parkinson's disease (PD). While this treatment has been available for decades, studies on long-term patient outcomes have been limited. Here, the authors examined survival and long-term outcomes of PD patients treated with DBS. METHODS The authors conducted a retrospective analysis using medical records of their patients to identify the first 400 consecutive patients who underwent DBS implantation at their institution from 1999 to 2007. The medical record was used to obtain baseline demographics and neurological status. The authors performed survival analyses using Kaplan-Meier estimation and multivariate regression using Cox proportional hazards modeling. Telephone surveys were used to determine long-term outcomes. RESULTS Demographics for the cohort of patients with PD (n = 320) were as follows: mean age of 61 years, 70% male, 27% of patients had at least 1 medical comorbidity (coronary artery disease, congestive heart failure, diabetes mellitus, atrial fibrillation, or deep vein thrombosis). Kaplan-Meier survival analysis on a subset of patients with at least 10 years of follow-up (n = 200) revealed a survival probability of 51% (mean age at death 73 years). Using multivariate regression, the authors found that age at implantation (HR 1.02, p = 0.01) and male sex (HR 1.42, p = 0.02) were predictive of reduced survival. Number of medical comorbidities was not significantly associated with survival (p > 0.5). Telephone surveys were completed by 40 surviving patients (mean age 55.1 ± 6.4 years, 72.5% male, 95% subthalamic nucleus DBS, mean follow-up 13.0 ± 1.7 years). Tremor responded best to DBS (72.5% of patients improved), while other motor symptoms remained stable. Ability to conduct activities of daily living (ADLs) remained stable (dressing, 78% of patients; running errands, 52.5% of patients) or worsened (preparing meals, 50% of patients). Patient satisfaction, however, remained high (92.5% happy with DBS, 95% would recommend DBS, and 75% felt it provided symptom control). CONCLUSIONS DBS for PD is associated with a 10-year survival rate of 51%. Survey data suggest that while DBS does not halt disease progression in PD, it provides durable symptomatic relief and allows many individuals to maintain ADLs over long-term follow-up greater than 10 years. Furthermore, patient satisfaction with DBS remains high at long-term follow-up.
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Gruber D, Südmeyer M, Deuschl G, Falk D, Krauss JK, Mueller J, Müller JU, Poewe W, Schneider GH, Schrader C, Vesper J, Volkmann J, Winter C, Kupsch A, Schnitzler A. Neurostimulation in tardive dystonia/dyskinesia: A delayed start, sham stimulation-controlled randomized trial. Brain Stimul 2018; 11:1368-1377. [DOI: 10.1016/j.brs.2018.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 08/12/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022] Open
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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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Hogg E, During E, E. Tan E, Athreya K, Eskenazi J, Wertheimer J, Mamelak AN, Alterman RL, Tagliati M. Sustained quality-of-life improvements over 10 years after deep brain stimulation for dystonia. Mov Disord 2018; 33:1160-1167. [DOI: 10.1002/mds.27426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Elliot Hogg
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Emmanuel During
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Echo E. Tan
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Kishore Athreya
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Jonathan Eskenazi
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Jeffrey Wertheimer
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Adam N. Mamelak
- Department of Neurosurgery; Cedar-Sinai Medical Center; Los Angeles California USA
| | - Ron L. Alterman
- Department of Neurosurgery; Beth Israel Deaconess Medical Center; Boston Massachusetts USA
| | - Michele Tagliati
- Department of Neurology; Cedar-Sinai Medical Center; Los Angeles California USA
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Macerollo A, Deuschl G. Deep brain stimulation for tardive syndromes: Systematic review and meta-analysis. J Neurol Sci 2018; 389:55-60. [DOI: 10.1016/j.jns.2018.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
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Deep brain stimulation for dystonia due to cerebral palsy: A review. Eur J Paediatr Neurol 2018; 22:308-315. [PMID: 29396170 DOI: 10.1016/j.ejpn.2017.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 01/08/2023]
Abstract
Cerebral palsy (CP) is a heterogeneous group of syndromes that cause a non-progressive disorder of early onset, with abnormal control of movement and posture. Various aetiologies can cause the CP clinical spectrum, but all have a disruption of motor control in common. CP can be divided into four major types based on the motor disability: predominant spastic, dyskinetic, ataxic and mixed form. Dyskinetic CP (DCP) is the most common cause of acquired dystonia in children. The treatment of DCP is challenging because most individuals have mixed degrees of chorea, athetosis and dystonia. Pharmacological treatment is often unsatisfactory. Functional neurosurgery, in particular deep brain stimulation targeting the basal ganglia or the cerebellum, is emerging as a promising therapeutic approach in selected patients with DCP. We evaluated herein the effects of DBS on patients with DCP in a review of published patient data in the largest available studies.
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Jahanshahi M. Neuropsychological and Neuropsychiatric Features of Idiopathic and DYT1 Dystonia and the Impact of Medical and Surgical treatment. Arch Clin Neuropsychol 2017; 32:888-905. [DOI: 10.1093/arclin/acx095] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 11/14/2022] Open
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Jahanshahi M, Torkamani M. The cognitive features of idiopathic and DYT1 dystonia. Mov Disord 2017. [DOI: 10.1002/mds.27048] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Marjan Jahanshahi
- Cognitive Motor Neuroscience Group; Sobell Department of Motor Neuroscience & Movement Disorders, University College London (UCL) Institute of Neurology, The National Hospital for Neurology & Neurosurgery; London UK
| | - Mariam Torkamani
- Cognitive Motor Neuroscience Group; Sobell Department of Motor Neuroscience & Movement Disorders, University College London (UCL) Institute of Neurology, The National Hospital for Neurology & Neurosurgery; London UK
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Koy A, Timmermann L. Deep brain stimulation in cerebral palsy: Challenges and opportunities. Eur J Paediatr Neurol 2017; 21:118-121. [PMID: 27289260 DOI: 10.1016/j.ejpn.2016.05.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 05/18/2016] [Accepted: 05/22/2016] [Indexed: 12/31/2022]
Abstract
Cerebral palsy (CP) is the most common cause for acquired dystonia in childhood. Pharmacological treatment is often unsatisfactory and side effects are frequently dose-limiting. Data on outcome of DBS in paediatric patients with dyskinetic CP is very limited and heterogeneous. Reasons for the variability in responses are not entirely known yet. Interestingly, some CP-patients seem to improve subjectively on pallidal stimulation but without measurable changes in impairment scales. Besides dystonia scales, the use of sensitive age-dependent assessments tools is therefore reasonable to capture the full effect. As the course of disease duration as well as the age at operation seem to correlate with DBS outcome in patients with dystonia, DBS at an early stage of development might be beneficial for some of these patients. For the future, well-conducted trials as well as data collection in the international registry is of major importance to increase knowledge about DBS in CP patients, especially those implanted at a young age. Furthermore, selection criteria and guidelines or treatment standards are needed to improve the service for children with dyskinetic CP - especially in light of unsatisfactory medical treatment options.
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Affiliation(s)
- Anne Koy
- Department of Neurology, University Hospital of Cologne, Germany; Department of Paediatrics, University Hospital of Cologne, Germany.
| | - Lars Timmermann
- Department of Neurology, University Hospital of Cologne, Germany
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What parents think and feel about deep brain stimulation in paediatric secondary dystonia including cerebral palsy: A qualitative study of parental decision-making. Eur J Paediatr Neurol 2017; 21:185-192. [PMID: 27658770 DOI: 10.1016/j.ejpn.2016.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/18/2016] [Accepted: 08/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dystonia is characterised by involuntary movements and postures. Deep Brain Stimulation (DBS) is effective in reducing dystonic symptoms in primary dystonia in childhood and to lesser extent in secondary dystonia. How families and children decide to choose DBS surgery has never been explored. AIMS To explore parental decision-making for DBS in paediatric secondary dystonia. METHODS Data was gathered using semi-structured interviews with eight parents of children with secondary dystonia who had undergone DBS. Interviews were analysed using Interpretative Phenomenological Analysis. RESULTS For all parents the decision was viewed as significant, with life altering consequences for the child. These results suggested that parents were motivated by a hope for a better life and parental duty. This was weighed against consideration of risks, what the child had to lose, and uncertainty of DBS outcome. Decisions were also influenced by the perspectives of their child and professionals. CONCLUSIONS The decision to undergo DBS was an ongoing process for parents, who ultimately were struggling in the face of uncertainty whilst trying to do their best as parents for their children. These findings have important clinical implications given the growing referrals for consideration of DBS childhood dystonia, and highlights the importance of further quantitative research to fully establish the efficacy of DBS in secondary dystonia to enhance informed decision-making.
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Koy A, Weinsheimer M, Pauls KAM, Kühn AA, Krause P, Huebl J, Schneider GH, Deuschl G, Erasmi R, Falk D, Krauss JK, Lütjens G, Schnitzler A, Wojtecki L, Vesper J, Korinthenberg R, Coenen VA, Visser-Vandewalle V, Hellmich M, Timmermann L. German registry of paediatric deep brain stimulation in patients with childhood-onset dystonia (GEPESTIM). Eur J Paediatr Neurol 2017; 21:136-146. [PMID: 27424797 DOI: 10.1016/j.ejpn.2016.05.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on paediatric deep brain stimulation (DBS) is limited, especially for long-term outcomes, because of small numbers in single center series and lack of systematic multi-center trials. OBJECTIVES We seek to systematically evaluate the clinical outcome of paediatric patients undergoing DBS. METHODS A German registry on paediatric DBS (GEPESTIM) was created to collect data of patients with dystonia undergoing DBS up to the age of 18 years. Patients were divided into three groups according to etiology (group 1 inherited, group 2 acquired, and group 3 idiopathic dystonia). RESULTS Data of 44 patients with a mean age of 12.8 years at time of operation provided by 6 German centers could be documented in the registry so far (group 1 n = 18, group 2 n = 16, group 3 n = 10). Average absolute improvement after implantation was 15.5 ± 18.0 for 27 patients with pre- and postoperative Burke-Fahn-Marsden Dystonia Rating scale movement scores available (p < 0.001) (group 1: 19.6 ± 19.7, n = 12; group 2: 7.0 ± 8.9, n = 8; group 3: 19.2 ± 20.7, n = 7). Infection was the main reason for hardware removal (n = 6). 20 IPG replacements due to battery expiry were necessary in 15 patients at 3.7 ± 1.8 years after last implantation. DISCUSSION Pre- and postoperative data on paediatric DBS are very heterogeneous and incomplete but corroborate the positive effects of DBS on inherited and acquired dystonia. Adverse events including relatively frequent IPG replacements due to battery expiry seem to be a prominent feature of children with dystonia undergoing DBS. The registry enables collaborative research on DBS treatment in the paediatric population and to create standardized management algorithms in the future.
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Affiliation(s)
- A Koy
- Department of Neurology, University Hospital of Cologne, Germany; Department of Paediatrics, University Hospital of Cologne, Germany.
| | - M Weinsheimer
- Department of Neurology, University Hospital of Cologne, Germany
| | - K A M Pauls
- Department of Neurology, University Hospital of Cologne, Germany
| | - A A Kühn
- Department of Neurology, Charité University Medicine Berlin, Germany
| | - P Krause
- Department of Neurology, Charité University Medicine Berlin, Germany
| | - J Huebl
- Department of Neurology, Charité University Medicine Berlin, Germany
| | - G-H Schneider
- Department of Neurosurgery, Charité University Medicine Berlin, Germany
| | - G Deuschl
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - R Erasmi
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - D Falk
- Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J K Krauss
- Department of Neurosurgery, Medical School, MHH, Hannover, Germany
| | - G Lütjens
- Department of Neurosurgery, Medical School, MHH, Hannover, Germany
| | - A Schnitzler
- Department of Neurology, University Hospital of Düsseldorf, Germany
| | - L Wojtecki
- Department of Neurology, University Hospital of Düsseldorf, Germany
| | - J Vesper
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Düsseldorf, Germany
| | - R Korinthenberg
- Department of Paediatrics, Freiburg University Medical Centre, Germany
| | - V A Coenen
- Department Stereotactic and Functional Neurosurgery, Freiburg University Medical Centre, Germany
| | - V Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - L Timmermann
- Department of Neurology, University Hospital of Cologne, Germany.
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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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Abstract
Objectives Although primary dystonia is typically characterized as a movement disorder, it is also associated with cognitive alterations in the domain of executive functioning which may arise from changes in cortico-basal ganglia circuits. Specifically, in comparison to healthy controls, patients with dystonia show deficits in neuropsychological tests of cognitive flexibility. However, it is unclear whether cognitive inflexibility is caused by the pathomechanisms underlying primary dystonia or by confounding factors such as depression or symptom-related distraction.Methods The present study aimed to eliminate these confounds by examining cognitive flexibility in dystonia patients and in patients with similar motor symptoms but without a comparable central pathophysiology. Eighteen patients with primary blepharospasm, a common form of dystonia affecting the muscles around the eyes, and 19 patients with hemifacial spasm, a facial nerve disorder causing similar eyelid spasms, completed a computerized version of the Wisconsin Card Sorting Test (cWCST). The two groups were further compared on tests of global cognitive functioning, psychiatric symptoms, health status, and impulsiveness. Results Blepharospasm patients committed significantly more errors on the cWCST than patients with hemifacial spasm. Group differences were most pronounced with regard to integration errors, a measure of rule-inference processes on the cWCST. Integration errors were also associated with impulsiveness in patients with blepharospasm. Conclusions Primary blepharospasm is related to deficits in cognitive flexibility, even when blepharospasm patients are compared with patients who suffer from motor symptoms of non-dystonic origin. Our results support the possibility that cognitive inflexibility results from the specific pathophysiological processes underlying primary dystonia. (JINS, 2016, 22, 662-670).
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Birska J, Zieliński P, Birski M, Harat M. Assessment of Cognitive Functioning after Pallidotomy in Patients with Primary Dystonia. Stereotact Funct Neurosurg 2016; 94:33-40. [DOI: 10.1159/000443019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 12/03/2015] [Indexed: 11/19/2022]
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Sobstyl M, Ząbek M. Deep brain stimulation for intractable tardive dystonia: Literature overview. Neurol Neurochir Pol 2016; 50:114-22. [PMID: 26969568 DOI: 10.1016/j.pjnns.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Tardive dystonia (TD) represents a side effect of prolonged intake of dopamine receptor blocking compounds. TD can be a disabling movement disorder persisting despite available medical treatment. Deep brain stimulation (DBS) has been reported successful in this condition although the number of treated patients with TD is still limited to small clinical studies or case reports. The aim of this study was to present the systematical overview of the existing literature regarding DBS for intractable TD. METHODS AND RESULTS A literature search was carried out in PudMed. Clinical case series or case reports describing the patients with TD after DBS treatment were included in the present overview. Literature search revealed 19 articles reporting 59 individuals operated for TD. GPi was the target in 55 patients, while subthalamic nucleus (STN) was the target in the remaining 4. In most studies the motor part of Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was improved by more than 80% when compared to preoperative BFMDRS scores. CONCLUSIONS The performed literature analysis indicates that bilateral GPi DBS is an effective treatment for disabling TD. The response of TD to bilateral GPi DBS may be very rapid and occurs within days/weeks after the procedure. The efficacy of bilateral GPi DBS in TD patients is comparable to results achieved in patients with primary generalized dystonia.
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Affiliation(s)
- Michał Sobstyl
- Neurosurgical Department of Postgraduate Medical Center, Warsaw, Poland.
| | - Mirosław Ząbek
- Neurosurgical Department of Postgraduate Medical Center, Warsaw, Poland.
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Morigaki R, Mure H, Kaji R, Nagahiro S, Goto S. Therapeutic Perspective on Tardive Syndrome with Special Reference to Deep Brain Stimulation. Front Psychiatry 2016; 7:207. [PMID: 28082923 PMCID: PMC5183634 DOI: 10.3389/fpsyt.2016.00207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/15/2016] [Indexed: 12/28/2022] Open
Abstract
Tardive syndrome (TDS) is a potentially permanent and irreversible hyperkinetic movement disorder caused by exposure to dopamine receptor blocking agents. Guidelines published by the American Academy of Neurology recommend pharmacological first-line treatment for TDS with clonazepam (level B), ginkgo biloba (level B), amantadine (level C), and tetrabenazine (level C). Recently, a class II study provided level C evidence for use of deep brain stimulation (DBS) of the globus pallidus internus (GPi) in patients with TDS. Although the precise pathogenesis of TDS remains to be elucidated, the beneficial effects of GPi-DBS in patients with TDS suggest that the disease may be a basal ganglia disorder. In addition to recent advances in understanding the pathophysiology of TDS, this article introduces the current use of DBS in the treatment of medically intractable TDS.
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Affiliation(s)
- Ryoma Morigaki
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurodegenerative Disorders Research, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hideo Mure
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryuji Kaji
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Clinical Neuroscience, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shinji Nagahiro
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Satoshi Goto
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurodegenerative Disorders Research, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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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: 16] [Impact Index Per Article: 1.8] [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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Mills KA, Markun LC, San Luciano M, Rizk R, Allen IE, Racine CA, Starr PA, Alberts JL, Ostrem JL. Effect of subthalamic nucleus deep brain stimulation on dual-task cognitive and motor performance in isolated dystonia. J Neurol Neurosurg Psychiatry 2015; 86:404-9. [PMID: 25012202 PMCID: PMC4392192 DOI: 10.1136/jnnp-2014-307942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Subthalamic nucleus (STN) deep brain stimulation (DBS) can improve motor complications of Parkinson's disease (PD) but may worsen specific cognitive functions. The effect of STN DBS on cognitive function in dystonia patients is less clear. Previous reports indicate that bilateral STN stimulation in patients with PD amplifies the decrement in cognitive-motor dual-task performance seen when moving from a single-task to dual-task paradigm. We aimed to determine if the effect of bilateral STN DBS on dual-task performance in isolated patients with dystonia, who have less cognitive impairment and no dementia, is similar to that seen in PD. METHODS Eight isolated predominantly cervical patients with dystonia treated with bilateral STN DBS, with average dystonia duration of 10.5 years and Montreal Cognitive Assessment score of 26.5, completed working memory (n-back) and motor (forced-maintenance) tests under single-task and dual-task conditions while on and off DBS. RESULTS A multivariate, repeated-measures analysis of variance showed no effect of stimulation status (On vs Off) on working memory (F=0.75, p=0.39) or motor function (F=0.22, p=0.69) when performed under single-task conditions, though as working memory task difficulty increased, stimulation disrupted the accuracy of force-tracking. There was a very small worsening in working memory performance (F=9.14, p=0.019) when moving from single-task to dual-tasks when using the 'dual-task loss' analysis. CONCLUSIONS This study suggests the effect of STN DBS on working memory and attention may be much less consequential in patients with dystonia than has been reported in PD.
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Affiliation(s)
- Kelly A Mills
- Department of Neurology, University of California, San Francisco, California, USA Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Leslie C Markun
- Department of Neurology, University of California, San Francisco, California, USA
| | - Marta San Luciano
- Department of Neurology, University of California, San Francisco, California, USA
| | - Rami Rizk
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - I Elaine Allen
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Caroline A Racine
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Philip A Starr
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, California, USA Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Smith KM, Spindler MA. Uncommon applications of deep brain stimulation in hyperkinetic movement disorders. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:278. [PMID: 25713746 PMCID: PMC4314611 DOI: 10.7916/d84x56hp] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/20/2014] [Indexed: 12/12/2022]
Abstract
Background In addition to the established indications of tremor and dystonia, deep brain stimulation (DBS) has been utilized less commonly for several hyperkinetic movement disorders, including medication-refractory myoclonus, ballism, chorea, and Gilles de la Tourette (GTS) and tardive syndromes. Given the lack of adequate controlled trials, it is difficult to translate published reports into clinical use. We summarize the literature, draw conclusions regarding efficacy when possible, and highlight concerns and areas for future study. Methods A Pubmed search was performed for English-language articles between January 1980 and June 2014. Studies were selected if they focused primarily on DBS to treat the conditions of focus. Results We identified 49 cases of DBS for myoclonus-dystonia, 21 for Huntington's disease, 15 for choreacanthocytosis, 129 for GTS, and 73 for tardive syndromes. Bilateral globus pallidus interna (GPi) DBS was the most frequently utilized procedure for all conditions except GTS, in which medial thalamic DBS was more common. While the majority of cases demonstrate some improvement, there are also reports of no improvement or even worsening of symptoms in each condition. The few studies including functional or quality of life outcomes suggest benefit. A limited number of studies included blinded on/off testing. There have been two double-blind controlled trials performed in GTS and a single prospective double-blind, uncontrolled trial in tardive syndromes. Patient characteristics, surgical target, stimulation parameters, and duration of follow-up varied among studies. Discussion Despite these extensive limitations, the literature overall supports the efficacy of DBS in these conditions, in particular GTS and tardive syndromes. For other conditions, the preliminary evidence from small studies is promising and encourages further study.
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Affiliation(s)
- Kara M Smith
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Meredith A Spindler
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Owen T, Gimeno H, Selway R, Lin JP. Cognitive function in children with primary dystonia before and after deep brain stimulation. Eur J Paediatr Neurol 2015; 19:48-55. [PMID: 25457508 DOI: 10.1016/j.ejpn.2014.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 09/02/2014] [Accepted: 09/29/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dystonia is characterised by involuntary movements (twisting, writhing and jerking) and postures. The effects of deep brain stimulation (DBS) surgery on the motor aspect of primary dystonias have been well reported, however, there is a paucity of research investigating its impact on cognitive function, particularly in childhood dystonia. We performed a follow-up of cognitive function in children with primary dystonia following DBS pallidal surgery. METHODS Cognitive function was measured in a cohort of 13 children with primary or primary plus dystonia who had undergone DBS surgery using a retrospective case series design. Baseline pre-DBS neuropsychological measures were compared to scores obtained at least one year following DBS. Cognitive function was assessed using standardised measures of intellectual ability and memory. RESULTS All children demonstrated improvements with regard to dystonia reduction, as measured by the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Overall, cognition remained stable following DBS in the majority of the cohort. Individual case analysis revealed improvements in some domains of cognitive function in eight members of the cohort and a deterioration of certain domains in four. CONCLUSION Cognition largely remained stable in children with primary/primary plus dystonia following DBS surgery, although further research with a larger sample is necessary to explore this statistically. Notwithstanding the limitations of a small size, this preliminary data has potentially positive implications for the impact of DBS on cognitive functioning within a paediatric population.
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Affiliation(s)
- Tamsin Owen
- Complex Motor Disorders Service, Paediatric Neurosciences, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Department of Clinical Psychology, Royal Holloway, University of London, UK.
| | - Hortensia Gimeno
- Complex Motor Disorders Service, Paediatric Neurosciences, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Richard Selway
- Functional Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Jean-Pierre Lin
- Complex Motor Disorders Service, Paediatric Neurosciences, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Quadruple deep brain stimulation in Huntington's disease, targeting pallidum and subthalamic nucleus: case report and review of the literature. J Neural Transm (Vienna) 2014; 121:1303-12. [PMID: 24699718 DOI: 10.1007/s00702-014-1201-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Deep brain stimulation (DBS) represents an established treatment option in a growing number of movement disorders. Recent case reports suggest beneficial effect of globus pallidus internus (GPi)-DBS in selected patients suffering from Huntington's disease with marked disabling chorea. We present a 41-year-old man with genetically confirmed HD following quadruple GPi- and subthalamic nucleus (STN)-DBS. Motor function was assessed by Abnormal Involuntary Movement Scale (AIMS) and by Unified Huntington Disease Rating Scale (UHDRS) presurgery and postsurgery for up to 4 years. Furthermore, cognitive, neuropsychiatric state and quality of life (QoL) including life satisfaction (QLS) were annually evaluated. Chorea assessed by AIMS and UHDRS subscores improved by 52 and 55 %, 45 and 60 %, 35 and 45 % and 55-66 % at 1-4 years, respectively, compared to presurgical state following GPi-STN-DBS. During these time periods bradykinesia did not increase following separate STN- and combined GPi-STN-DBS compared to presurgical state. Mood, QoL and QLS were ameliorated. However, dysexecutive symptoms increased at 4 years postsurgery. The present case report suggests that bilateral GPi- and STN-DBS may represent a new treatment avenue in selected HD patients. Clinically, GPi-DBS attenuated chorea and was associated with a larger effect-adverse effect window compared to STN-DBS. However, GPi-DBS-induced bradykinesia may emerge as one main limitation of GPi-DBS in HD. Thus, quadruple GPi-STN-DBS may be indicated, if separate GPi-DBS does not result in sufficient control of motor symptoms. Future controlled studies need to confirm if the present anecdotal observation of additive beneficial effects of GPi- and STN-DBS in a HD patient with severe generalized chorea and relatively intact cognitive and affective functions indeed represents a new therapeutic option.
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Calheiros-Trigo F, Linhares P. Evaluation of the efficacy of deep brain stimulation in the surgical treatment of cervical dystonia. Neurocirugia (Astur) 2014; 25:49-55. [DOI: 10.1016/j.neucir.2013.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
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Hedera P. Treatment of Wilson's disease motor complications with deep brain stimulation. Ann N Y Acad Sci 2014; 1315:16-23. [DOI: 10.1111/nyas.12372] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Peter Hedera
- Department of Neurology; Vanderbilt University; Nashville Tennessee
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Quinn DK, Deligtisch A, Rees C, Brodsky A, Evans D, Khafaja M, Abbott CC. Differential diagnosis of psychiatric symptoms after deep brain stimulation for movement disorders. Neuromodulation 2014; 17:629-36; discussion 636. [PMID: 24512146 DOI: 10.1111/ner.12153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 11/28/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The presence of a deep brain stimulator (DBS) in a patient with a movement disorder who develops psychiatric symptoms poses unique diagnostic and therapeutic challenges for the treating clinician. Few sources discuss approaches to diagnosing and treating these symptoms. MATERIALS AND METHODS The authors review the literature on psychiatric complications in DBS for movement disorders and propose a heuristic for categorizing symptoms according to their temporal relationship with the DBS implantation process. RESULTS Psychiatric symptoms after DBS can be categorized as preimplantation, intra-operative/perioperative, stimulation related, device malfunction, medication related, and chronic stimulation related/long term. Once determined, the specific etiology of a symptom guides the practitioner in treatment. CONCLUSIONS A structured approach to psychiatric symptoms in DBS patients allows practitioners to effectively diagnose and treat them when they arise.
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Affiliation(s)
- Davin K Quinn
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Woopen C, Pauls KAM, Koy A, Moro E, Timmermann L. Early application of deep brain stimulation: Clinical and ethical aspects. Prog Neurobiol 2013; 110:74-88. [DOI: 10.1016/j.pneurobio.2013.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 04/10/2013] [Accepted: 04/16/2013] [Indexed: 11/25/2022]
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Pallidal stimulation for primary generalised dystonia: effect on cognition, mood and quality of life. J Neurol 2013; 261:164-73. [PMID: 24178706 PMCID: PMC3895192 DOI: 10.1007/s00415-013-7161-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 10/12/2013] [Indexed: 12/03/2022]
Abstract
We investigated the effect of pallidal deep brain stimulation (GPi-DBS) in dystonia on cognition, mood, and quality of life and also assessed if DYT1 gene status influenced cognitive outcome following GPi-DBS. Fourteen patients with primary generalized dystonia (PGD) were assessed, measuring their estimated premorbid and current IQ, memory for words and faces, and working memory, language, executive function, and sustained attention, one month before and one year or more after surgery. Changes in mood and behaviour and quality of life were also assessed. There was a significant improvement of dystonia with GPi-DBS (69 % improvement in Burke-Fahn-Marsden score, p < 0.0001). Performance on five cognitive tests either improved or declined at post-surgical follow-up. Calculation of a reliable change index suggested that deterioration in sustained attention on the PASAT was the only reliable change (worse after surgery) in cognition with GPi-DBS. DYT1 gene status did not influence cognitive outcome following GPi-DBS. Depression, anxiety and apathy were not significantly altered, and ratings of health status on the EQ5D remained unchanged. In our sample, GPi-DBS was only associated with an isolated deficit on a test of sustained attention, confirming that GPi-DBS in PGD is clinically effective and safe, without adverse effects on the main domains of cognitive function. The dissociation between GPi-DBS improving dystonia, but not having a significant positive impact on the patients’ QoL, warrants further investigation.
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Mills KA, Starr PA, Ostrem JL. Neuromodulation for dystonia: target and patient selection. Neurosurg Clin N Am 2013; 25:59-75. [PMID: 24262900 DOI: 10.1016/j.nec.2013.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment of dystonia refractory to oral medications or botulinum toxin injections includes the use of deep brain stimulation (DBS). Expectations should be established based on patient-related factors, including type of dystonia, genetic cause, target symptoms, age at the time of surgery, disease duration, or the presence of fixed skeletal deformities. Premorbid conditions such as psychiatric illness and cognitive impairment should be considered. Target selection is an emerging issue in DBS for dystonia. Although efficacy has been established for targeting the globus pallidus internus for dystonia, other brain targets such as the subthalamic nucleus, thalamus, or cortex may be promising alternatives.
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Affiliation(s)
- Kelly A Mills
- UCSF Department of Neurology, PADRECC, San Francisco VA Medical Center, UCSF Box 1838, 1635 Divisadero Street, Suite 520, San Francisco, CA 94143-1838, USA
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Abstract
The few controlled studies that have been carried out have shown that bilateral internal globus pallidum stimulation is a safe and long-term effective treatment for hyperkinetic disorders. However, most recent published data on deep brain stimulation (DBS) for dystonia, applied to different targets and patients, are still mainly from uncontrolled case reports (especially for secondary dystonia). This precludes clear determination of the efficacy of this procedure and the choice of the 'good' target for the 'good' patient. We performed a literature analysis on DBS for dystonia according to the expected outcome. We separated those with good evidence of favourable outcome from those with less predictable outcome. In the former group, we review the main results for primary dystonia (generalised/focal) and highlight recent data on myoclonus-dystonia and tardive dystonia (as they share, with primary dystonia, a marked beneficial effect from pallidal stimulation with good risk/benefit ratio). In the latter group, poor or variable results have been obtained for secondary dystonia (with a focus on heredodegenerative and metabolic disorders). From this overview, the main results and limits for each subgroup of patients that may help in the selection of dystonic patients who will benefit from DBS are discussed.
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Affiliation(s)
- Marie Vidailhet
- AP-HP, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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Anderson D, Kartha N. Deep Brain Stimulation in Nonparkinsonian Movement Disorders and Emerging Technologies, Targets, and Therapeutic Promises in Deep Brain Stimulation. Neurol Clin 2013; 31:809-26. [DOI: 10.1016/j.ncl.2013.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Trinh B, Ha AD, Mahant N, Kim SD, Owler B, Fung VSC. Dramatic improvement of truncal tardive dystonia following globus pallidus pars interna deep brain stimulation. J Clin Neurosci 2013; 21:515-7. [PMID: 23790619 DOI: 10.1016/j.jocn.2013.03.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/30/2013] [Indexed: 11/29/2022]
Abstract
Truncal predominant tardive dystonia is an uncommon presentation of dystonia, and may be associated with significant disability. We report a patient with near-complete resolution of severe, disabling truncal tardive dystonia following globus pallidus pars interna deep brain stimulation. Her unusual clinical presentation highlights the difficulties in diagnosing unusual forms of dystonia, and the therapeutic gains that can be achieved once the diagnosis is recognised.
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Affiliation(s)
- Benson Trinh
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Ainhi D Ha
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Neil Mahant
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Samuel D Kim
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Brian Owler
- Department of Neurosurgery, Westmead Hospital, Westmead, NSW, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.
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Vidailhet M, Jutras MF, Roze E, Grabli D. Deep brain stimulation for dystonia. HANDBOOK OF CLINICAL NEUROLOGY 2013; 116:167-187. [PMID: 24112893 DOI: 10.1016/b978-0-444-53497-2.00014-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The few reported controlled studies show that bilateral stimulation of the globus pallidus interna (GPi) is a safe and effective long-term treatment for hyperkinetic disorders. However, the recently published data on deep brain stimulation (DBS) applied to different targets or patients (especially those with secondary dystonia) are mainly uncontrolled case reports, precluding a clear determination of its efficacy, and providing little guidance as to the choice of a "good" target in a "good" patient. This chapter reviews the literature on DBS in primary dystonia, paying particular attention to the risk:benefit ratio in focal and segmental dystonias (cervical dystonia, cranial dystonia) and to the predictive factors for a good outcome. The chapter also highlights recent data on the marked benefits of the technique in myoclonus dystonia (in which pallidal, as opposed to thalamic, stimulation is more effective) and in tardive dystonia-dyskinesia. Although, the decision to treat appears relatively straightforward in patients with primary dystonia, myoclonus-dystonia, and tardive dystonia who have a normal findings on magnetic resonance imaging and normal cognitive function, there are still no reliable tools to help predict the timescale of postoperative benefit. This chapter provides a comprehensive analysis of the use of the treatment in various types of secondary dystonia, with little to moderate benefit in most cases, based on single cases or small series. Beyond the reduction in the severity of dystonia, the global motor and functional outcome is difficult to determine owing to the paucity of adequate evaluation tools. Because of the large interpatient variability, different targets may be effective depending on the symptoms in each individual.
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Affiliation(s)
- Marie Vidailhet
- Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Research Center of the Brain and Spinal Cord Institute, Université Paris 6/Inserm UMR S975, Paris, France; Pierre et Marie Curie Paris-6 University, Paris, France
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Al-Harbi KS, Qureshi NA. Neuromodulation therapies and treatment-resistant depression. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2012; 5:53-65. [PMID: 23152710 PMCID: PMC3496963 DOI: 10.2147/mder.s33198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). Objective This paper aims to review evidence-based data on the use of NTs in TRD. Method Using keywords and combined-word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving relevant articles published in English-language peer-reviewed journals (2000–2012). Those papers that addressed NTs in TRD were retained for extensive review. Results Despite methodological challenges, a range of 30%–93% of TRD patients showed substantial improvement to one of the NTs. One hundred–percent improvement was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may unlock the biological basis underlying mood disorders including TRD. Conclusion NTs are promising in patients with TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need further technological refinements and optimization together with continuing well-designed studies that recruit larger numbers of participants with TRD.
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Spindler MA, Galifianakis NB, Wilkinson JR, Duda JE. Globus pallidus interna deep brain stimulation for tardive dyskinesia: case report and review of the literature. Parkinsonism Relat Disord 2012; 19:141-7. [PMID: 23099106 DOI: 10.1016/j.parkreldis.2012.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 09/13/2012] [Accepted: 09/29/2012] [Indexed: 12/27/2022]
Abstract
Tardive dyskinesia (TD) can be a disabling condition and is frequently refractory to medical therapy. Over the past decade there have been many reports of TD patients experiencing significant benefit with deep brain stimulation (DBS) of the globus pallidus interna (GPi). The growing literature on this treatment option for TD consists predominantly of case reports and series. The reported benefit ranges widely, but the majority of cases experienced at least a 50% improvement in symptoms. The anatomical distribution of dyskinesias has not clearly influenced outcome, though fixed postures appear less likely to improve than phasic movements. Onset of benefit can be immediate or take months, and benefit is sustained in most cases, for at least 6 months and up to several years. A wide variety of voltages, frequencies, and pulse widths have demonstrated efficacy. A small number of reports which examined psychiatric symptoms before and after surgery did not find any decline, and in some cases revealed improvement in mood. However, these overall positive results should be interpreted with caution, as the majority of reports lacked blinded assessments, control groups, or standardized therapy parameters. Finally, we present an illustrative case of refractory tardive dyskinesia treated with GPi-DBS with 5 years of follow-up and 4 accompanying video segments.
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Affiliation(s)
- Meredith A Spindler
- Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
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Lumsden DE, Kaminska M, Tustin K, Gimeno H, Baker L, Ashkan K, Selway R, Lin JP. Battery life following pallidal deep brain stimulation (DBS) in children and young people with severe primary and secondary dystonia. Childs Nerv Syst 2012; 28:1091-7. [PMID: 22427261 DOI: 10.1007/s00381-012-1728-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The finite life of non-rechargeable batteries powering implantable pulse generators (IPG) necessitates their periodic replacement. Children receiving deep brain stimulation (DBS) may require frequent battery changes over their treatment lifetime. OBJECTIVES We aimed to determine the battery life of IPGs used in pallidal DBS for the treatment of dystonia in children and young people. METHODS We make use of a review of case notes of all children and young people undergoing DBS surgery at our institution from June 2005 to May 2010. RESULTS A total of 54 children and young people underwent surgery on at least one occasion, with a total of 76 IPGs implanted. Replacement IPGs due to battery failure were required in 15 out of 54 (27.8%). The average time to battery failure was 24.5 ± 2.9 months (95% confidence interval), with a range of 13-39 months. Battery life was significantly longer in primary compared to subsequent IPGs. No difference in longevity was seen between different IPG devices. CONCLUSIONS IPG battery life may be short in children and young people receiving treatment for dystonia. These findings highlight the potential benefits of the recently introduced rechargeable neurostimulators.
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Affiliation(s)
- Daniel E Lumsden
- Complex Motor Disorder Service, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK
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