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Subthalamic Nucleus Stimulation in Pediatric Isolated Dystonia: A 10-Year Follow-up. Can J Neurol Sci 2021; 47:328-335. [PMID: 32252836 DOI: 10.1017/cjn.2020.32] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the short-term and long-term clinical effectiveness and safety of subthalamic nucleus deep brain stimulation (STN-DBS) for medically intractable pediatric isolated dystonia. METHODS Using a longitudinal retrospective design, we assessed the clinical outcomes of nine patients who underwent STN-DBS for treatment-refractory pediatric isolated dystonia one decade ago (mean age at surgery: 15.9 ± 4.5 years). The primary clinical outcome used was assessed by retrospective video analyses of patients' dystonia symptoms using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Clinical assessments were performed at baseline, 1-year follow-up (1-yr FU), and 10-year follow-up (10-yr FU). Adverse side effects, including surgery-related, device-related, and stimulation-related effects, were also documented. RESULTS After STN-DBS surgery, the mean improvement in the BFMDRS motor score was 77.1 ± 26.6% at 1-yr FU and 90.4 ± 10.4% at 10-yr FU. Similarly, the mean BFMDRS disability score was improved by 69.5 ± 13.6% at 1-yr FU and by 86.5 ± 13.9% at 10-yr FU. The clinical improvements gained at 10-yr FU were significantly larger than those observed at 1-yr FU. Negative correlations were found between the duration of disease to age at surgery ratio (DD/AS) and the improvements in the BFMDRS motor score and total score at 1-yr FU and 10-yr FU. CONCLUSION To our knowledge, this study provides the first clinical evidence for the short- and long-term effectiveness and safety of STN-DBS for pediatric isolated dystonia. Additionally, putative evidence is provided that earlier STN-DBS intervention in patients with refractory pediatric isolated dystonia may improve short- and long-term clinical outcomes.
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2
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Investigating DYT1 in a Taiwanese dystonia cohort. J Formos Med Assoc 2021; 121:375-380. [PMID: 34092466 DOI: 10.1016/j.jfma.2021.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/01/2021] [Accepted: 05/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND/PURPOSE A heterozygous three-nucleotide (GAG) in-frame deletion in the TOR1A gene causes the rare disease, dystonia (DYT1), which typically presents as focal limb dystonia during adolescence, then spreads to other limbs. This study investigated the frequency and clinical features of DYT1 in a Taiwanese dystonia cohort. METHODS We performed targeted next generation sequencing in 318 patients with primary dystonia. We identified one DYT1 family with various types of dystonia, and we described the clinical presentations observed in this family during a 30-year follow-up. We compared the clinical characteristics to those reported in previous studies on DYT1 from 2000 to 2020. RESULTS Among 318 patients, we identified only one DYT1 patient (0.3%) with an autosomal dominant family history of dystonia. The proband was a 43-year-old man that experienced progressive onset of focal lower limb dystonia from age 11 years. The disease spread caudal-rostrally to the upper limbs and cervical muscles. Prominent cervical dystonia was noted during follow-up, which was an atypical presentation of DYT1. Clinical assessments of other family members showed intrafamily variability. The proband's father and an affected sibling demonstrated only mild right-hand writer's cramp. A systematic review of previously reported DTY1 cases showed that Asian patients had a higher frequency of cervical dystonia (44.8%) than groups of Ashkenazi Jews (35%) and Non-Jewish Caucasians (30.5%) (P = 0.04). CONCLUSION Our findings revealed that DYT1 is rare in a Taiwanese dystonia cohort. The presentation of marked cervical dystonia could be the main feature of Asian patients with DYT1.
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Coblentz A, Elias GJB, Boutet A, Germann J, Algarni M, Oliveira LM, Neudorfer C, Widjaja E, Ibrahim GM, Kalia SK, Jain M, Lozano AM, Fasano A. Mapping efficacious deep brain stimulation for pediatric dystonia. J Neurosurg Pediatr 2021; 27:346-356. [PMID: 33385998 DOI: 10.3171/2020.7.peds20322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to report the authors' experience with deep brain stimulation (DBS) of the internal globus pallidus (GPi) as a treatment for pediatric dystonia, and to elucidate substrates underlying clinical outcome using state-of-the-art neuroimaging techniques. METHODS A retrospective analysis was conducted in 11 pediatric patients (6 girls and 5 boys, mean age 12 ± 4 years) with medically refractory dystonia who underwent GPi-DBS implantation between June 2009 and September 2017. Using pre- and postoperative MRI, volumes of tissue activated were modeled and weighted by clinical outcome to identify brain regions associated with clinical outcome. Functional and structural networks associated with clinical benefits were also determined using large-scale normative data sets. RESULTS A total of 21 implanted leads were analyzed in 11 patients. The average follow-up duration was 19 ± 20 months (median 5 months). Using a 7-point clinical rating scale, 10 patients showed response to treatment, as defined by scores < 3. The mean improvement in the Burke-Fahn-Marsden Dystonia Rating Scale motor score was 40% ± 23%. The probabilistic map of efficacy showed that the voxel cluster most associated with clinical improvement was located at the posterior aspect of the GPi, comparatively posterior and superior to the coordinates of the classic GPi target. Strong functional and structural connectivity was evident between the probabilistic map and areas such as the precentral and postcentral gyri, parietooccipital cortex, and brainstem. CONCLUSIONS This study reported on a series of pediatric patients with dystonia in whom GPi-DBS resulted in variable clinical benefit and described a clinically favorable stimulation site for this cohort, as well as its structural and functional connectivity. This information could be valuable for improving surgical planning, simplifying programming, and further informing disease pathophysiology.
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Affiliation(s)
- Ailish Coblentz
- 1Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto
| | | | - Alexandre Boutet
- 2University Health Network, Toronto
- 3Joint Department of Medical Imaging, University of Toronto
| | | | - Musleh Algarni
- 4Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
| | - Lais M Oliveira
- 4Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
| | | | - Elysa Widjaja
- 1Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto
| | - George M Ibrahim
- 5Department of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Suneil K Kalia
- 3Joint Department of Medical Imaging, University of Toronto
- 7Krembil Brain Institute, Toronto; and
- 8Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Mehr Jain
- 6Faculty of Medicine, University of Ottawa
| | | | - Alfonso Fasano
- 4Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
- 7Krembil Brain Institute, Toronto; and
- 8Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
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4
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Miterko LN, Lin T, Zhou J, van der Heijden ME, Beckinghausen J, White JJ, Sillitoe RV. Neuromodulation of the cerebellum rescues movement in a mouse model of ataxia. Nat Commun 2021; 12:1295. [PMID: 33637754 PMCID: PMC7910465 DOI: 10.1038/s41467-021-21417-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
Deep brain stimulation (DBS) relieves motor dysfunction in Parkinson's disease, and other movement disorders. Here, we demonstrate the potential benefits of DBS in a model of ataxia by targeting the cerebellum, a major motor center in the brain. We use the Car8 mouse model of hereditary ataxia to test the potential of using cerebellar nuclei DBS plus physical activity to restore movement. While low-frequency cerebellar DBS alone improves Car8 mobility and muscle function, adding skilled exercise to the treatment regimen additionally rescues limb coordination and stepping. Importantly, the gains persist in the absence of further stimulation. Because DBS promotes the most dramatic improvements in mice with early-stage ataxia, we postulated that cerebellar circuit function affects stimulation efficacy. Indeed, genetically eliminating Purkinje cell neurotransmission blocked the ability of DBS to reduce ataxia. These findings may be valuable in devising future DBS strategies.
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Affiliation(s)
- Lauren N. Miterko
- grid.39382.330000 0001 2160 926XDepartment of Pathology and Immunology, Baylor College of Medicine, Houston, TX USA ,grid.39382.330000 0001 2160 926XProgram in Developmental Biology, Baylor College of Medicine, Houston, TX USA ,grid.416975.80000 0001 2200 2638Jan and Dan Duncan Neurological Research Institute of Texas Children’s Hospital, Houston, TX USA
| | - Tao Lin
- grid.39382.330000 0001 2160 926XDepartment of Pathology and Immunology, Baylor College of Medicine, Houston, TX USA ,grid.416975.80000 0001 2200 2638Jan and Dan Duncan Neurological Research Institute of Texas Children’s Hospital, Houston, TX USA
| | - Joy Zhou
- grid.39382.330000 0001 2160 926XDepartment of Pathology and Immunology, Baylor College of Medicine, Houston, TX USA ,grid.416975.80000 0001 2200 2638Jan and Dan Duncan Neurological Research Institute of Texas Children’s Hospital, Houston, TX USA ,grid.39382.330000 0001 2160 926XDepartment of Neuroscience, Baylor College of Medicine, Houston, TX USA
| | - Meike E. van der Heijden
- grid.39382.330000 0001 2160 926XDepartment of Pathology and Immunology, Baylor College of Medicine, Houston, TX USA ,grid.416975.80000 0001 2200 2638Jan and Dan Duncan Neurological Research Institute of Texas Children’s Hospital, Houston, TX USA
| | - Jaclyn Beckinghausen
- grid.39382.330000 0001 2160 926XDepartment of Pathology and Immunology, Baylor College of Medicine, Houston, TX USA ,grid.416975.80000 0001 2200 2638Jan and Dan Duncan Neurological Research Institute of Texas Children’s Hospital, Houston, TX USA ,grid.39382.330000 0001 2160 926XDepartment of Neuroscience, Baylor College of Medicine, Houston, TX USA
| | - Joshua J. White
- grid.39382.330000 0001 2160 926XDepartment of Pathology and Immunology, Baylor College of Medicine, Houston, TX USA ,grid.416975.80000 0001 2200 2638Jan and Dan Duncan Neurological Research Institute of Texas Children’s Hospital, Houston, TX USA ,grid.39382.330000 0001 2160 926XDepartment of Neuroscience, Baylor College of Medicine, Houston, TX USA
| | - Roy V. Sillitoe
- grid.39382.330000 0001 2160 926XDepartment of Pathology and Immunology, Baylor College of Medicine, Houston, TX USA ,grid.39382.330000 0001 2160 926XProgram in Developmental Biology, Baylor College of Medicine, Houston, TX USA ,grid.416975.80000 0001 2200 2638Jan and Dan Duncan Neurological Research Institute of Texas Children’s Hospital, Houston, TX USA ,grid.39382.330000 0001 2160 926XDepartment of Neuroscience, Baylor College of Medicine, Houston, TX USA ,grid.39382.330000 0001 2160 926XDevelopment, Disease Models & Therapeutics Graduate Program, Baylor College of Medicine, Houston, TX USA
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5
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Tsuboi T, Cif L, Coubes P, Ostrem JL, Romero DA, Miyagi Y, Lozano AM, De Vloo P, Haq I, Meng F, Sharma N, Ozelius LJ, Wagle Shukla A, Cauraugh JH, Foote KD, Okun MS. Secondary Worsening Following DYT1 Dystonia Deep Brain Stimulation: A Multi-country Cohort. Front Hum Neurosci 2020; 14:242. [PMID: 32670041 PMCID: PMC7330126 DOI: 10.3389/fnhum.2020.00242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
Objective: To reveal clinical characteristics of suboptimal responses to deep brain stimulation (DBS) in a multi-country DYT1 dystonia cohort. Methods: In this multi-country multi-center retrospective study, we analyzed the clinical data of DYT1 patients who experienced suboptimal responses to DBS defined as <30% improvement in dystonia scales at the last follow-up compared with baseline. We used a literature-driven historical cohort of 112 DYT1 patients for comparison. Results: Approximately 8% of our study cohort (11 out of 132) experienced suboptimal responses to DBS. Compared with the historical cohort, the multi-country cohort with suboptimal responses had a significantly younger age at onset (mean, 7.0 vs. 8.4 years; p = 0.025) and younger age at DBS (mean, 12.0 vs. 18.6 years; p = 0.019). Additionally, cranial involvement was more common in the multi-country cohort (before DBS, 64% vs. 45%, p = 0.074; before or after DBS, 91% vs. 47%, p = 0.001). Mean motor improvement at the last follow-up from baseline were 0% and 66% for the multi-country and historical cohorts, respectively. All 11 patients of the multi-country cohort had generalization of dystonia within 2.5 years after disease onset. All patients experienced dystonia improvement of >30% postoperatively; however, secondary worsening of dystonia commenced between 6 months and 3 years following DBS. The improvement at the last follow-up was less than 30% despite optimally-placed leads, a trial of multiple programming settings, and additional DBS surgeries in all patients. The on-/off-stimulation comparison at the long-term follow-up demonstrated beneficial effects of DBS despite missing the threshold of 30% improvement over baseline. Conclusion: Approximately 8% of patients represent a more aggressive phenotype of DYT1 dystonia characterized by younger age at onset, faster disease progression, and cranial involvement, which seems to be associated with long-term suboptimal responses to DBS (e.g., secondary worsening). This information could be useful for both clinicians and patients in clinical decision making and patient counseling before and following DBS implantations. Patients with this phenotype may have different neuroplasticity, neurogenetics, or possibly distinct neurophysiology.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Laura Cif
- Department of Neurology, University Hospital Montpellier, Montpellier, France
| | - Philippe Coubes
- Department of Neurosurgery, University Hospital Montpellier, Montpellier, France
| | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Danilo A Romero
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Yasushi Miyagi
- Department of Stereotactic and Functional Neurosurgery, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital Krembil Neuroscience Center, Toronto, ON, Canada.,Department of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Philippe De Vloo
- Department of Neurosurgery, University of Toronto, Toronto, ON, Canada.,Department of Neurosurgery, KU Leuven, Leuven, Belgium
| | - Ihtsham Haq
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Fangang Meng
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Laurie J Ozelius
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Aparna Wagle Shukla
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - James H Cauraugh
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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6
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Koy A, Bockhorn N, Kühn A, Schneider GH, Krause P, Lauritsch K, Witt K, Paschen S, Deuschl G, Krauss J, Saryyeva A, Runge J, Borggraefe I, Mehrkens J, Horn A, Vesper J, Schnitzler A, Siegert S, Freilinger M, Eckenweiler M, Coenen V, Tadic V, Voges J, Pauls K, Wirths J, Timmermann L, Hellmich M, Abdallat M, Ascencao LC, Grünwald S, Wloch A, Schrader C, Groiss SJ, Wojtecki L. Adverse events associated with deep brain stimulation in patients with childhood-onset dystonia. Brain Stimul 2019; 12:1111-1120. [DOI: 10.1016/j.brs.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 11/29/2022] Open
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7
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Long-term effect of subthalamic and pallidal deep brain stimulation for status dystonicus in children with methylmalonic acidemia and GNAO1 mutation. J Neural Transm (Vienna) 2019; 126:739-757. [DOI: 10.1007/s00702-019-02010-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/05/2019] [Indexed: 01/09/2023]
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8
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Tsuboi T, Jabarkheel Z, Foote KD, Okun MS, Wagle Shukla A. Importance of the initial response to GPi deep brain stimulation in dystonia: A nine year quality of life study. Parkinsonism Relat Disord 2019; 64:249-255. [PMID: 31060987 DOI: 10.1016/j.parkreldis.2019.04.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Long-term efficacy of deep brain stimulation (DBS) on health-related quality-of-life (HRQoL) for isolated dystonia is not well established. This study aims to determine the long-term impact of DBS on HRQoL outcomes and identify clinical predictors. METHODS We retrospectively investigated 16 inherited or idiopathic isolated dystonia patients treated with bilateral globus pallidus internus DBS who were followed beyond 9 years at our center. The cohort consisted of 9 males, 7 females; 10 generalized, 6 segmental; mean (range) age at implantation, 37.0 (8-67) years; mean follow-up duration after implantation, 10.9 (9-13) years. We employed the Unified Dystonia Rating Scale for motor and Short Form Health Survey for HRQoL assessments to monitor the change longitudinally. We analyzed the changes in motor and HRQoL at 1-2 years (short-term) and ≥9 years (long-term) follow-up as compared to baseline with a Wilcoxon signed-rank test. We assessed the factors that predicted motor and HRQoL improvement with univariate regression analyses. RESULTS Motor (41.6%; p = 0.004) and HRQoL (total score, p = 0.039) improvements remained significant at long-term follow-up and, in the regression analysis, change in HRQoL outcomes correlated significantly with change in motor outcomes (R2 = 0.384, p = 0.010). Additionally, short-term motor and HRQoL improvements predicted the long-term motor (R2 = 0.384, p = 0.010) and HRQoL (total score, R2 = 0.594, p < 0.001) outcomes, respectively. CONCLUSION Motor and HRQoL improvements with DBS in isolated dystonia remain sustained for nearly a decade and may largely be predictable by the short-term response to DBS.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Zakia Jabarkheel
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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9
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Deep brain stimulation in pediatric dystonia: a systematic review. Neurosurg Rev 2018; 43:873-880. [PMID: 30397842 DOI: 10.1007/s10143-018-1047-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/21/2018] [Accepted: 10/29/2018] [Indexed: 01/12/2023]
Abstract
While deep brain stimulation (DBS) treatment is relatively rare in children, it may have a role in dystonia to reduce motor symptoms and disability. Pediatric DBS studies are sparse and limited by small sample size, and thus, outcomes are poorly understood. Thus, we performed a systematic review of the literature including studies of DBS for pediatric (age < 21) dystonia. Patient demographics, disease causes and characteristics, motor scores, and disability scores were recorded at baseline and at last post-operative follow-up. We identified 19 studies reporting DBS outcomes in 76 children with dystonia. Age at surgery was 13.8 ± 3.9 (mean ± SD) years, and 58% of individuals were male. Post-operative follow-up duration was 2.8 ± 2.8 years. Sixty-eight percent of patients had primary dystonia (PD), of whom 56% had a pathological mutation in DYT1 (DYT1+). Across all patients, regardless of dystonia type, 43.8 ± 36% improvement was seen in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor (-M) scores after DBS, while 43.7 ± 31% improvement was observed in BFMDRS disability (-D) scores. Patients with PD were more likely to experience ≥ 50% improvement (56%) in BFMDRS-M scores compared to patients with secondary causes of dystonia (21%, p = 0.004). DYT1+ patients were more likely to achieve ≥ 50% improvement (65%) in BFMDRS-D than DTY1- individuals (29%, p = 0.02), although there was no difference in BFMDRS-M ≥ 50% improvement rates between DYT1+ (66%) or DYT1- (43%) children (p = 0.11). While DBS is less common in pediatric patients, individuals with severe dystonia may receive worthwhile benefit with neuromodulation treatment.
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10
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Candela S, Vanegas MI, Darling A, Ortigoza-Escobar JD, Alamar M, Muchart J, Climent A, Ferrer E, Rumià J, Pérez-Dueñas B. Frameless robot-assisted pallidal deep brain stimulation surgery in pediatric patients with movement disorders: precision and short-term clinical results. J Neurosurg Pediatr 2018; 22:416-425. [PMID: 30028274 DOI: 10.3171/2018.5.peds1814] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to verify the safety and accuracy of the Neuromate stereotactic robot for use in deep brain stimulation (DBS) electrode implantation for the treatment of hyperkinetic movement disorders in childhood and describe the authors' initial clinical results. METHODS A prospective evaluation of pediatric patients with dystonia and other hyperkinetic movement disorders was carried out during the 1st year after the start-up of a pediatric DBS unit in Barcelona. Electrodes were implanted bilaterally in the globus pallidus internus (GPi) using the Neuromate robot without the stereotactic frame. The authors calculated the distances between the electrodes and their respective planned trajectories, merging the postoperative CT with the preoperative plan using VoXim software. Clinical outcome was monitored using validated scales for dystonia and myoclonus preoperatively and at 1 month and 6 months postoperatively and by means of a quality-of-life questionnaire for children, administered before surgery and at 6 months' follow-up. We also recorded complications derived from the implantation technique, "hardware," and stimulation. RESULTS Six patients aged 7 to 16 years and diagnosed with isolated dystonia ( DYT1 negative) (3 patients), choreo-dystonia related to PDE2A mutation (1 patient), or myoclonus-dystonia syndrome SGCE mutations (2 patients) were evaluated during a period of 6 to 19 months. The average accuracy in the placement of the electrodes was 1.24 mm at the target point. At the 6-month follow-up, patients showed an improvement in the motor (65%) and functional (48%) components of the Burke-Fahn-Marsden Dystonia Rating Scale. Patients with myoclonus and SGCE mutations also showed an improvement in action myoclonus (95%-100%) and in functional tests (50%-75%) according to the Unified Motor-Rating Scale. The Neuro-QOL score revealed inconsistent results, with improvement in motor function and social relationships but worsening in anxiety, cognitive function, and pain. The only surgical complication was medial displacement of the first electrode, which limited intensity of stimulation in the lower contacts, in one case. CONCLUSIONS The Neuromate stereotactic robot is an accurate and safe tool for the placement of GPi electrodes in children with hyperkinetic movement disorders.
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Affiliation(s)
- Santiago Candela
- Departments of1Neurosurgery.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
| | - María Isabel Vanegas
- 2Neuropediatrics, and.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona.,7Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Alejandra Darling
- 2Neuropediatrics, and.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
| | - Juan Darío Ortigoza-Escobar
- 2Neuropediatrics, and.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
| | - Mariana Alamar
- Departments of1Neurosurgery.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
| | - Jordi Muchart
- 3Diagnostic Imaging.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
| | - Alejandra Climent
- Departments of1Neurosurgery.,2Neuropediatrics, and.,4Intraoperative Neurophysiology Unit, and.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
| | - Enrique Ferrer
- Departments of1Neurosurgery.,5Department of Neurosurgery, Hospital Clinic de Barcelona, Universitat de Barcelona; and.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
| | - Jordi Rumià
- Departments of1Neurosurgery.,5Department of Neurosurgery, Hospital Clinic de Barcelona, Universitat de Barcelona; and.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona
| | - Belén Pérez-Dueñas
- 2Neuropediatrics, and.,6Pediatric Movement Disorders Unit, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona.,7Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
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11
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Elkaim LM, De Vloo P, Kalia SK, Lozano AM, Ibrahim GM. Deep brain stimulation for childhood dystonia: current evidence and emerging practice. Expert Rev Neurother 2018; 18:773-784. [DOI: 10.1080/14737175.2018.1523721] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lior M. Elkaim
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Phillippe De Vloo
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Canada
| | - George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Canada
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Koy A, Cirak S, Gonzalez V, Becker K, Roujeau T, Milesi C, Baleine J, Cambonie G, Boularan A, Greco F, Perrigault PF, Cances C, Dorison N, Doummar D, Roubertie A, Beroud C, Körber F, Stüve B, Waltz S, Mignot C, Nava C, Maarouf M, Coubes P, Cif L. Deep brain stimulation is effective in pediatric patients with GNAO1 associated severe hyperkinesia. J Neurol Sci 2018; 391:31-39. [DOI: 10.1016/j.jns.2018.05.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/21/2018] [Indexed: 12/27/2022]
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Nerrant E, Gonzalez V, Milesi C, Vasques X, Ruge D, Roujeau T, De Antonio Rubio I, Cyprien F, Seng EC, Demailly D, Roubertie A, Boularan A, Greco F, Perrigault PF, Cambonie G, Coubes P, Cif L. Deep brain stimulation treated dystonia-trajectory via status dystonicus. Mov Disord 2018; 33:1168-1173. [PMID: 29786895 DOI: 10.1002/mds.27357] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/30/2017] [Accepted: 01/11/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Status dystonicus (SD) is a life-threatening condition. OBJECTIVE AND METHODS In a dystonia cohort who developed status dystonicus, we analyzed demographics, background dystonia phenomenology and complexity, trajectory previous to-, via status dystonicus episodes, and evolution following them. RESULTS Over 20 years, 40 of 328 dystonia patients who were receiving DBS developed 58 status dystonicus episodes. Dystonia was of pediatric onset (95%), frequently complex, and had additional cognitive and pyramidal impairment (62%) and MRI alterations (82.5%); 40% of episodes occured in adults. Mean disease duration preceding status dystonicus was 10.3 ± 8 years. Evolution time to status dystonicus varied from days to weeks; however, 37.5% of patients exhibited progressive worsening over years. Overall, DBS was efficient in resolving 90% of episodes. CONCLUSION Status dystonicus is potentially reversible and a result of heterogeneous conditions with nonuniform underlying physiology. Recognition of the complex phenomenology, morphological alterations, and distinct patterns of evolution, before and after status dystonicus, will help our understanding of these conditions. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Elodie Nerrant
- Département de Neurochirurgie, Centre Hospitalier Régional Montpellier, France.,Unité de Recherche sur les Comportements et Mouvements Anormaux (URCMA), Montpellier, France.,Université Montpellier, 34000, Montpellier, France
| | - Victoria Gonzalez
- Département de Neurochirurgie, Centre Hospitalier Régional Montpellier, France.,Unité de Recherche sur les Comportements et Mouvements Anormaux (URCMA), Montpellier, France.,Université Montpellier, 34000, Montpellier, France
| | - Christophe Milesi
- Université Montpellier, 34000, Montpellier, France.,Département Pédiatrie néonatale et réanimations; Centre Hospitalier Régional Montpellier, Montpellier, France
| | - Xavier Vasques
- Laboratoire de Recherche en Neurosciences Cliniques (LRENC), Montpellier, France.,IBM Systems, IBM, Montpellier, France
| | - Diane Ruge
- Department of Psychology and Neurosciences. Leibniz Research Centre for Working Environment and Human Factors, Technical University Dortmund, Dortmund, Germany
| | - Thomas Roujeau
- Département de Neurochirurgie, Centre Hospitalier Régional Montpellier, France.,Université Montpellier, 34000, Montpellier, France
| | - Isabel De Antonio Rubio
- Département de Neurochirurgie, Centre Hospitalier Régional Montpellier, France.,Unité de Recherche sur les Comportements et Mouvements Anormaux (URCMA), Montpellier, France.,Université Montpellier, 34000, Montpellier, France
| | - Fabienne Cyprien
- Département de Neurochirurgie, Centre Hospitalier Régional Montpellier, France.,Unité de Recherche sur les Comportements et Mouvements Anormaux (URCMA), Montpellier, France.,Inserm U1061, Hôpital La Colombière, Montpellier, France
| | - Emilie Chan Seng
- Département de Neurochirurgie, Centre Hospitalier Régional Montpellier, France.,Université Montpellier, 34000, Montpellier, France.,INSERM U 1051, Institut des Neurosciences Montpellier, Montpellier, France
| | - Diane Demailly
- Département de Neurochirurgie, Centre Hospitalier Régional Montpellier, France.,Université Montpellier, 34000, Montpellier, France
| | - Agathe Roubertie
- Université Montpellier, 34000, Montpellier, France.,Département de Neuropédiatrie, Centre Hospitalier Régional Montpellier, Montpellier, France
| | - Alain Boularan
- Université Montpellier, 34000, Montpellier, France.,Anesthésie-Réanimation Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France
| | - Fréderic Greco
- Université Montpellier, 34000, Montpellier, France.,Anesthésie-Réanimation Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France
| | - Pierre-François Perrigault
- Université Montpellier, 34000, Montpellier, France.,Anesthésie-Réanimation Gui de Chauliac, Centre Hospitalier Régional Montpellier, Montpellier, France
| | - Gilles Cambonie
- Université Montpellier, 34000, Montpellier, France.,Département Pédiatrie néonatale et réanimations; Centre Hospitalier Régional Montpellier, Montpellier, France
| | - Philippe Coubes
- Département de Neurochirurgie, Centre Hospitalier Régional Montpellier, France.,Unité de Recherche sur les Comportements et Mouvements Anormaux (URCMA), Montpellier, France.,Université Montpellier, 34000, Montpellier, France
| | - Laura Cif
- Département de Neurochirurgie, Centre Hospitalier Régional Montpellier, France.,Unité de Recherche sur les Comportements et Mouvements Anormaux (URCMA), Montpellier, France.,Université Montpellier, 34000, Montpellier, France
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