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Ozturk S, Temel Y, Aygun D, Kocabicak E. Deep Brain Stimulation of the Globus Pallidus Internus for Secondary Dystonia: Clinical Cases and Systematic Review of the Literature Regarding the Effectiveness of Globus Pallidus Internus versus Subthalamic Nucleus. World Neurosurg 2021; 154:e495-e508. [PMID: 34303854 DOI: 10.1016/j.wneu.2021.07.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is a frequently applied therapy in primary dystonia. For secondary dystonia, the effects can be less favorable. We share our long-term findings in 9 patients with severe secondary dystonia and discuss these findings in the light of the literature. METHODS Patients who had undergone globus pallidus internus (GPi)-DBS for secondary dystonia were included. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores, clinical improvement rates, follow-up periods, stimulation parameters and the need for internal pulse generator replacements were analyzed. The PubMed and Google Scholar databases were searched for articles describing GPi-DBS and subthalamic nucleus (STN)-DBS only for secondary dystonia cases. Keywords were "dystonia," "deep brain stimulation," "GPi," "dystonia," "deep brain stimulation," and "STN." RESULTS A total of 9 secondary dystonia patients (5 male, 4 female) had undergone GPi-DBS with microelectrode recording in our units. The mean follow-up period was 29 months. The average BFMDRS score was 58.2 before the surgery, whereas the mean value was 36.5 at the last follow-up of the patients (mean improvement, 39%; minimum, 9%; maximum, 63%). In the literature review, we identified 264 GPi-DBS cases (mean follow-up, 19 months) in 72 different articles about secondary dystonia. The mean BFMDRS improvement rate was 52%. In 146 secondary dystonia cases, reported in 19 articles, STN-DBS was performed. The average follow-up period was 20 months and the improvement in BFMDRS score was 66%. CONCLUSIONS Although GPi-DBS has favorable long-term efficacy and safety in the treatment of patients with secondary dystonia, STN seems a promising target for stimulation in patients with secondary dystonia. Further studies including a large number of patients, longer follow-up periods, and more homogenous patients are necessary to establish the optimal target for DBS in the management of secondary dystonias.
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Affiliation(s)
- Sait Ozturk
- Department of Neurosurgery, School of Medicine, Fırat University, Elazig, Turkey.
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dursun Aygun
- Department of Neurology, Ondokuz Mayıs University, Samsun, Turkey
| | - Ersoy Kocabicak
- Department of Neurosurgery, Ondokuz Mayıs University, Samsun, Turkey; Neuromodulation Center, Ondokuz Mayıs University, Samsun, Turkey
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Ostrem JL, San Luciano M, Dodenhoff KA, Ziman N, Markun LC, Racine CA, de Hemptinne C, Volz MM, Heath SL, Starr PA. Subthalamic nucleus deep brain stimulation in isolated dystonia: A 3-year follow-up study. Neurology 2016; 88:25-35. [PMID: 27903810 DOI: 10.1212/wnl.0000000000003451] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report long-term safety and efficacy outcomes of a large cohort of patients with medically refractory isolated dystonia treated with subthalamic nucleus (STN) deep brain stimulation (DBS). METHODS Twenty patients (12 male, 8 female; mean age 49 ± 16.3 years) with medically refractory isolated dystonia were studied (14 were followed for 36 months). The primary endpoints were change in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor score and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score at 36 months compared to preoperative baseline. Multiple secondary outcomes were also assessed (ClinicalTrials.gov NCT00773604). RESULTS Eighteen of 20 patients showed improvement 12 months after STN DBS with sustained benefit persisting for 3 years (n = 14). At 36 months, BFMDRS motor scores improved 70.4% from a mean 17.9 ± 8.5 to 5.3 ± 5.6 (p = 0.0002) and total TWSTRS scores improved 66.6% from a mean 41.0 ± 18.9 to 13.7 ± 17.9 (p = 0.0002). Improvement at 36 months was equivalent to that seen at 6 months. Disability and quality of life measures were also improved. Three hardware-related and 24 stimulation-related nonserious adverse events occurred between years 1 and 3 (including 4 patients with dyskinesia). CONCLUSIONS This study offers support for long-term tolerability and sustained effectiveness of STN DBS in the treatment of severe forms of isolated dystonia. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that STN DBS decreases long-term dystonia severity in patients with medically refractory isolated dystonia.
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Affiliation(s)
- Jill L Ostrem
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
| | - Marta San Luciano
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Kristen A Dodenhoff
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Nathan Ziman
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Leslie C Markun
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Caroline A Racine
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Coralie de Hemptinne
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Monica M Volz
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Susan L Heath
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Philip A Starr
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
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