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Marsili L, Keeling EG, Maciel R, Contarino MF, Zutt R, Okun MS, Almeida L, Deeb W, Kern D, Macias‐Garcia D, Carrillo F, Mir P, Merola A, Espay AJ, Fasano A. Functional Movement Disorders and Deep Brain Stimulation: A Multi-Center Study. Mov Disord Clin Pract 2023; 10:94-100. [PMID: 36704077 PMCID: PMC9847284 DOI: 10.1002/mdc3.13609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background Functional movement disorders (FMD) are a commonly under-recognized diagnosis in patients with underlying neurodegenerative diseases. FMD have been observed in patients undergoing deep brain stimulation (DBS) for Parkinson's disease (PD) and other movement disorders. The prevalence of coexisting FMD among movement disorder-related DBS patients is unknown, and it may occur more often than previously recognized. Methods We retrospectively assessed the relative prevalence and clinical characteristics of FMD occurring post-DBS, in PD and dystonia patients (FMD+, n = 29). We compared this cohort with age at surgery-, sex-, and diagnosis-matched subjects without FMD post-DBS (FMD-, n = 29). Results Both the FMD prevalence (0.2%-2.1%) and the number of cases/DBS procedures/year varied across centers (0.15-3.65). A total of nine of 29 FMD+ cases reported worse outcomes following DBS. Although FMD+ and FMD- manifested similar features, FMD+ showed higher psychiatric comorbidity. Conclusions DBS may be complicated by the development of FMD in a subset of patients, particularly those with pre-morbid psychiatric conditions.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's disease and Movement DisordersCincinnatiOhioUSA
| | - Elizabeth G. Keeling
- School of Life SciencesArizona State UniversityTempeArizonaUSA
- Barrow Neurological InstitutePhoenixArizonaUSA
| | - Ricardo Maciel
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNTorontoOntarioCanada
- Canada Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Maria Fiorella Contarino
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
- Department of NeurologyHaga teaching HospitalThe HagueThe Netherlands
| | - Rodi Zutt
- Department of NeurologyHaga teaching HospitalThe HagueThe Netherlands
| | - Michael S. Okun
- Departments of Neurology and NeurosurgeryNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Leonardo Almeida
- Departments of Neurology and NeurosurgeryNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Wissam Deeb
- Departments of Neurology and NeurosurgeryNorman Fixel Institute for Neurological Diseases, University of FloridaGainesvilleFloridaUSA
| | - Drew Kern
- Departments of Neurology and NeurosurgeryUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Daniel Macias‐Garcia
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología ClínicaInstituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSevilleSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Fatima Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología ClínicaInstituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSevilleSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología ClínicaInstituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de SevillaSevilleSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
- Departamento de MedicinaFacultad de Medicina, Universidad de SevillaSevilleSpain
| | - Aristide Merola
- Department of NeurologyThe Ohio State Wexner Medical CenterColumbusOhioUSA
| | - Alberto J. Espay
- Gardner Family Center for Parkinson's disease and Movement DisordersCincinnatiOhioUSA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNTorontoOntarioCanada
- Canada Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA)TorontoOntarioCanada
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Dystonia: Still a Mysterious Syndrome. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070989. [PMID: 35888079 PMCID: PMC9321350 DOI: 10.3390/life12070989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 12/02/2022]
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Gorodetsky C, Azevedo P, Fasano A. Functional Patients Referred for Deep Brain Stimulation: How Common is it? Mov Disord Clin Pract 2022; 9:841-842. [DOI: 10.1002/mdc3.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/26/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Carolina Gorodetsky
- Division of Neurology The Hospital for Sick Children Toronto Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology University of Toronto Toronto Ontario Canada
| | - Paula Azevedo
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology University of Toronto Toronto Ontario Canada
| | - Alfonso Fasano
- Division of Neurology The Hospital for Sick Children Toronto Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology University of Toronto Toronto Ontario Canada
- Krembil Brain Institute Toronto Ontario Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto ON Canada
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Gorodetsky C, Azevedo P, Candeias da Silva C, Fasano A. Factors Influencing the Surgical Decision in Dystonia Patients Referred for Deep Brain Stimulation. Toxins (Basel) 2021; 13:toxins13080511. [PMID: 34437382 PMCID: PMC8402533 DOI: 10.3390/toxins13080511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
There is no available data on the journey of dystonia patients once referred to a tertiary center to undergo deep brain stimulation (DBS). We hypothesized that some patients might be incorrectly diagnosed while others might decline the procedure or experience significant benefit with switching to a different botulinum neurotoxin (BoNT). This is a single-center, retrospective study of dystonia patients who were referred to the DBS program between January 2014 and December 2018. We collected data on the surgical decision as well as factors influencing this decision. Sixty-seven patients were included (30 males, mean age: 48.3 ± 20.1 years, disease duration: 16.9 ± 15.3 years). Thirty-three (49%) patients underwent DBS. Four (6%) patients were awaiting the procedure while the remaining 30 patients (45%) did not undergo DBS. Reasons for DBS decline were patient refusal (17, 53%), functional dystonia (6, 20%), and successful use of AbobotulinumtoxinA (3, 10%) in patients who had failed other BoNTs. Our study highlights the importance of structured patient education to increase acceptance of DBS, as well as careful patient evaluation, particularly with respect to functional dystonia. Finally, changing BoNT formulation might be beneficial in some patients.
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Affiliation(s)
- Carolina Gorodetsky
- Division of Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada; (P.A.); (C.C.d.S.)
- Division of Neurology, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Paula Azevedo
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada; (P.A.); (C.C.d.S.)
- Division of Neurology, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Carolina Candeias da Silva
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada; (P.A.); (C.C.d.S.)
- Division of Neurology, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Alfonso Fasano
- Division of Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada; (P.A.); (C.C.d.S.)
- Division of Neurology, University of Toronto, Toronto, ON M5S 3H2, Canada
- Krembil Brain Institute, Toronto, ON M5T 1M8, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON M5T 1M8, Canada
- Correspondence:
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