Bilateral Pallidal Stimulation Improves Chorea in Antiphospholipid Antibody Syndrome With Oral Anticoagulation

Schrader, Christoph; M, Aumüller; Lütjens, G.; Saryyeva, Assel; Capelle, Hans‐Holger; Krauss, Joachim K.

doi:10.1002/mdc3.12146

Cited by 3 publications

(2 citation statements)

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“…Another study showed that postoperative prophylaxis with or without subcutaneous heparin for venous thromboembolism did not increase the risk for intracranial hemorrhage significantly [ 5 ]. More detailed analysis of the handling of chronic anticoagulation treatment in patients undergoing DBS or with existing DBS systems has been provided mainly in the form of case report or small case series [ 4 , 25 , 31 , 33 , 39 ]. We have reported previously on a patient who received bilateral pallidal DBS for severe chorea due to antiphospholipid antibody syndrome with a need for chronic phenprocoumon treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The question, however, arises whether an established therapy such as DBS can be denied to these groups of patients. While many neurosurgeons worldwide perform DBS in patients with chronic antiplatelet or anticoagulation treatment, there is very limited published data addressing this problem [ 4 , 25 , 31 , 33 , 36 ]. Furthermore, there are different drugs for antiplatelet or anticoagulation treatment, each with distinctive mechanisms and duration of action.…”

Section: Introductionmentioning

confidence: 99%

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Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment

et al. 2021

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Background In the aging society, many patients with movement disorders, pain syndromes, or psychiatric disorders who are candidates for deep brain stimulation (DBS) surgery suffer also from cardiovascular co-morbidities that require chronic antiplatelet or anticoagulation treatment. Because of a presumed increased risk of intracranial hemorrhage during or after surgery and limited knowledge about perioperative management, chronic antiplatelet or anticoagulation treatment often has been considered a relative contraindication for DBS. Here, we evaluate whether or not there is an increased risk for intracranial hemorrhage or thromboembolic complications in patients on chronic treatment (paused for surgery or bridged with subcutaneous heparin) as compared to those without. Methods Out of a series of 465 patients undergoing functional stereotactic neurosurgery, 34 patients were identified who were on chronic treatment before and after receiving DBS. In patients with antiplatelet treatment, medication was stopped in the perioperative period. In patients with vitamin K antagonists or novel oral anticoagulants (NOACs), heparin was used for bridging. All patients had postoperative stereotactic CT scans, and were followed up for 1 year after surgery. Results In patients on chronic antiplatelet or anticoagulation treatment, intracranial hemorrhage occurred in 2/34 (5.9%) DBS surgeries, whereas the rate of intracranial hemorrhage was 15/431 (3.5%) in those without, which was statistically not significant. Implantable pulse generator pocket hematomas were seen in 2/34 (5.9%) surgeries in patients on chronic treatment and in 4/426 (0.9%) without. There were only 2 instances of thromboembolic complications which both occurred in patients without chronic treatment. There were no hemorrhagic complications during follow-up for 1 year. Conclusions DBS surgery in patients on chronic antiplatelet or anticoagulation treatment is feasible. Also, there was no increased risk of hemorrhage in the first year of follow-up after DBS surgery. Appropriate patient selection and standardized perioperative management are necessary to reduce the risk of intracranial hemorrhage and thromboembolic complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment

et al. 2021

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Tetrabenazine/tiapride

2017

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Dancing with disorder: chorea – an unusual and neglected manifestation of antiphospholipid syndrome

Hu,

Zhou,

et al. 2024

Lupus Sci Med

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ObjectivesChorea, characterised by involuntary, irregular movements, is a rare neurological manifestation of antiphospholipid syndrome (APS). The specific clinical features remain unclear. This study aimed to summarise the available evidence on antiphospholipid antibody (aPL)-associated chorea.MethodsWe used a mixed-methods approach, combining data from patients with chorea with aPL positivity admitted to Peking Union Medical College Hospital (PUMCH) from 2014 to 2024, with cases identified in public databases since 1983. We collected and analysed clinical, laboratory, and imaging results, along with their treatments and outcomes.ResultsA total of 180 patients with incident aPL-associated chorea were included (13 from PUMCH and 167 from the literature). The majority (81.7%) were female, with a mean age of chorea onset 22.8 years (SD=16.0). Chorea was the initial symptom in 87.9% of cases and often occurred as a single episode (67%), involving bilateral limbs (58.8%) and both upper and lower limbs (87.2%). 43.3% met the 2023 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) APS classification criteria. Thrombocytopenia (30.0%) and arterial thrombosis (29.1%) were the most common manifestations. Lupus anticoagulant was positive in 84.2% of patients, anticardiolipin IgG in 70.8%, and anti-β2 glycoprotein I IgG in 52.9%. Among those who had results available for the three tests, 57.6% were triple-positive. ANAs were positive in 63.6%. MRI revealed basal ganglia lesions in only 14.8% of patients, whereas all positron emission tomography (PET) scans showed contralateral striatal hypermetabolism. Treatment varied, with most receiving combination therapies of neuroleptics, anticoagulants, antiplatelets, steroids and immunosuppressants. Chorea completely or partially improved in 95.5% of patients.ConclusionChorea is a significant but under-recognised manifestation of APS, predominantly affecting young women and often presenting as the initial symptom. Characteristic PET findings of contralateral striatal hypermetabolism can assist in diagnosis. Treatments with glucocorticoids and immunosuppressive therapies appear beneficial. Further research is needed to understand the pathophysiology and optimise management strategies for aPL-associated chorea.

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Bilateral Pallidal Stimulation Improves Chorea in Antiphospholipid Antibody Syndrome With Oral Anticoagulation

Cited by 3 publications

References 6 publications

Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment

Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment

Tetrabenazine/tiapride

Dancing with disorder: chorea – an unusual and neglected manifestation of antiphospholipid syndrome

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