Predictive factors of outcome in primary cervical dystonia following pallidal deep brain stimulation

Witt, Jennifer; Moro, Elena; Ash, Rima S.; Hamani, Clement; Starr, Philip A.; Lozano, Andrés M.; Hodaie, Mojgan; Poon, Yu‐Yan; Markun, Leslie C.; Ostrem, Jill L.

doi:10.1002/mds.25560

Cited by 32 publications

(15 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For the CD population, surgery is typically performed at an older age than GD given the later disease presentation. Several studies have not seen a correlation of better outcomes with a shorter disease duration at time of surgery and younger age at time of surgery as potentially in the GD population [5,9,32]. In this study, the CD good responders were younger and had a shorter disease duration at time of surgery as compared to CD poor responders, suggesting that, with our population, performing surgery earlier was beneficial.…”

Section: Discussioncontrasting

confidence: 49%

The Optimal Pallidal Target in Deep Brain Stimulation for Dystonia: A Study Using a Functional Atlas Based on Nonlinear Image Registration

Tolleson¹,

Pallavaram²,

Li³

et al. 2014

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

Background: Deep brain stimulation (DBS) of the globus pallidus internus is established as efficacious for dystonia, yet the optimal target within this structure is not well defined. Published evidence suggests that spatial normalization provides a better estimate of DBS lead location than traditional methods based on standard stereotactic coordinates. Methods: We retrospectively reviewed our pallidal implanted dystonia population. Patient imaging scans were morphed into an MRI atlas using a nonlinear image registration algorithm. Active contact locations were projected onto the atlas and clusters analyzed for the degree of variance in two groups: (1) good and poor responders and (2) cervical (CD) and generalized dystonia (GD). Results: The average active contact location between CD and GD good responders was distinct but not significantly different. The mean active contact for CD poor responders was significantly different from CD responders and GD poor responders in the dorsoventral direction. Conclusions: A normalized imaging space is arguably more accurate in visualizing postoperative leads. Despite some separation between groups, this data suggests there was not an optimal pallidal target for common dystonia patients. Degrees of variance overlapped due to a large degree of individual target variation. Patient selection may ultimately be the key to maximizing patient outcomes. © 2014 S. Karger AG, Basel

show abstract

Section: Discussioncontrasting

confidence: 49%

The Optimal Pallidal Target in Deep Brain Stimulation for Dystonia: A Study Using a Functional Atlas Based on Nonlinear Image Registration

Tolleson¹,

Pallavaram²,

Li³

et al. 2014

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

show abstract

“…However, data regarding predictors of surgical outcome in patients with CD are conflicting. While one study reported better surgical outcomes in patients with shorter disease duration (Yamada et al, 2013), another found no evidence for any such correlation (Witt et al, 2013). We also observed a significant negative correlation between the proportion of life lived with CD and firing rates in the GPi.…”

Section: Discussionmentioning

confidence: 99%

Asymmetric pallidal neuronal activity in patients with cervical dystonia

Moll

Galindo-Leon

Sharott

et al. 2014

Front. Syst. Neurosci.

View full text Add to dashboard Cite

The origin of asymmetric clinical manifestation of symptoms in patients suffering from cervical dystonia (CD) is hitherto poorly understood. Dysregulated neuronal activity in the basal ganglia has been suggested to have a role in the pathophysiology of CD. Here, we re-assessed the question to what extent relative changes occur in the direct vs. indirect basal ganglia pathway in CD, whether these circuit changes are lateralized, and how these alterations relate to CD symptoms. To this end, we recorded ongoing single cell and local field potential (LFP) activity from the external (GPe) and internal pallidal segment (GPi) of 13 CD patients undergoing microelectrode-guided stereotactic surgery for deep brain stimulation in the GPi. We compared pallidal recordings from CD patients operated under local anaesthesia (LA) with those obtained in CD patients operated under general anaesthesia (GA). In awake patients, mean GPe discharge rate (52 Hz) was lower than that of GPi (72 Hz). Mean GPi discharge ipsilateral to the side of head turning was higher than contralateral and correlated with torticollis symptom severity. Lateralized differences were absent at the level of the GPe and in recordings from patients operated under GA. Furthermore, in the GPi of CD patients there was a subpopulation of theta-oscillatory cells with unique bursting characteristics. Power and coherence of GPe– and GPi–LFPs were dominated by a theta peak and also exhibited band-specific interhemispheric differences. Strong cross-frequency coupling of low-gamma amplitude to theta phase was a feature of pallidal LFPs recorded under LA, but not GA. These results indicate that CD is associated with an asymmetric pallidal outflow. Based on the finding of symmetric neuronal discharges in the GPe, we propose that an imbalanced interhemispheric direct pathway gain may be involved in CD pathophysiology.

show abstract

“…This suggests that perhaps earlier DBS in patients with severe cervical dystonia may lead to more favorable results. Yet another study of 28 patients with idiopathic cervical dystonia and bilateral GPi DBS found no correlation between disease duration, age at onset, baseline severity, and response [57]. The presence of lateral shift was associated with less robust improvement.…”

Section: Surgical Treatmentsmentioning

confidence: 95%

“…Bilateral GPi DBS has been shown to be effective for patients with cervical dystonia who do not obtain sufficient benefit from botulinum toxin [53,54]. Long-term benefit greater than 5 years has been reported in single-blind, open-label, and retrospective studies [54][55][56][57]. One retrospective study evaluating predictive factors of response to stimulation in cervical dystonia found that longer disease duration negatively correlated with magnitude of response, while age and disease severity did not [58].…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Treatment of Dystonia

Thenganatt

Jankovic

2014

Neurotherapeutics

View full text Add to dashboard Cite

Selecting the appropriate treatment for dystonia begins with proper classification of disease based on age, distribution, and underlying etiology. The therapies available for dystonia include oral medications, botulinum toxin, and surgical procedures. Oral medications are generally reserved for generalized and segmental dystonia. Botulinum toxin revolutionized the treatment of focal dystonia when it was introduced for therapeutic purposes in the 1980s. Surgical procedures are available for medication-refractory dystonia, markedly affecting an individual's quality of life.

show abstract

Predictive factors of outcome in primary cervical dystonia following pallidal deep brain stimulation

Abstract: Although this is the largest study supporting efficacy of bilateral pallidal DBS in primary CD, no major clinical predictive outcomes of surgical benefit were identified.

Cited by 32 publications

References 35 publications

The Optimal Pallidal Target in Deep Brain Stimulation for Dystonia: A Study Using a Functional Atlas Based on Nonlinear Image Registration

The Optimal Pallidal Target in Deep Brain Stimulation for Dystonia: A Study Using a Functional Atlas Based on Nonlinear Image Registration

Asymmetric pallidal neuronal activity in patients with cervical dystonia

Treatment of Dystonia

Contact Info

Product

Resources

About