Chronic Deep Brain Stimulation for Segmental Dystonia

Woehrle, Johannes C.; Blahak, Christian; Kekelia, Kety; Capelle, Hans‐Holger; Baezner, Hansjoerg; Grips, Eva; Weigel, Ralf; Krauss, Joachim K.

doi:10.1159/000249819

Cited by 60 publications

(31 citation statements)

References 34 publications

(22 reference statements)

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“…It demonstrates clearly that chronic DBS of the posteroventral lateral GPi yields sustained improvement in patients with camptocormia due to dystonia. The effect on camptocormia with pallidal DBS is comparable with the range of improvement for dystonia in general [7,8,11,19,20]. Changes of objective measurements for camptocormia were paralleled by patients' self rating indices postoperatively.…”

Section: Discussionmentioning

confidence: 56%

Deep brain stimulation for camptocormia in dystonia and Parkinson’s disease

et al. 2010

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Camptocormia, or "bent spine syndrome", may occur in various movement disorders such as primary dystonia or idiopathic Parkinson's disease (PD). Although deep brain stimulation (DBS) is an established treatment in refractory primary dystonia and advanced PD, few data are available on the effect of DBS on camptocormia comparing these two conditions. Seven patients (4 with dystonia, 3 with PD; mean age 60.3 years at surgery, range 39-73 years) with camptocormia were included in the study. Five patients underwent bilateral GPi DBS and two patients underwent bilateral STN DBS guided by CT-stereotactic surgery and microelectrode recording. Pre- and postoperative motor assessment included the BFM in the dystonia patients and the UPDRS in the PD patients. Severity of camptocormia was assessed by the BFM subscore for the trunk at the last available follow-up at a mean of 17.3 months (range 9-36 months). There were no surgical complications. In the four patients with dystonia there was a mean improvement of 53% in the BFM motor score (range 41-79%) and of 63% (range 50-67%) in the BFM subscore for the trunk at the last available follow-up (mean 14.3 months, range 9-18 months). In the three patients with camptocormia in PD who underwent bilateral STN DBS (2 patients) or pallidal DBS (1 patient), the PD symptoms improved markedly (mean improvement in the UPDRS motor subscore stimulation on/medication off 55%, range 49-61%), but there was no or only mild improvement of camptocormia in the two patients who underwent STN DBS, and only moderate improvement in the patient with GPi DBS at the last available follow-up (mean 21 months, range 12-36 months). GPi DBS is an effective treatment for camptocormia in dystonia. The response of camptocormia to chronic STN or GPi DBS in PD is more heterogenous. The latter may be due to a variety of causes and needs further clarification.

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Section: Discussionmentioning

confidence: 56%

Deep brain stimulation for camptocormia in dystonia and Parkinson’s disease

et al. 2010

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“…38 However, the main improvement seems to be during the first 6 months. 8,37 In our study, we therefore considered 6 months of observation to be sufficient.…”

Section: Discussionmentioning

confidence: 99%

A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia

Schjerling

Hjermind

Jespersen

et al. 2013

JNS

105

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Object The authors' aim was to compare the subthalamic nucleus (STN) with the globus pallidus internus (GPi) as a stimulation target for deep brain stimulation (DBS) for medically refractory dystonia. Methods In a prospective double-blind crossover study, electrodes were bilaterally implanted in the STN and GPi of 12 patients with focal, multifocal, or generalized dystonia. Each patient was randomly selected to undergo initial bilateral stimulation of either the STN or the GPi for 6 months, followed by bilateral stimulation of the other nucleus for another 6 months. Preoperative and postoperative ratings were assessed by using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and video recordings. Quality of life was evaluated by using questionnaires (36-item Short Form Health Survey). Supplemental Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed for patients with focal dystonia (torticollis) by examining the video recordings. Results On average for all patients, DBS improved the BFMDRS movement scores (p < 0.05) and quality of life physical scores (p < 0.01). After stimulation of the STN, the mean 6-month improvement in BFMDRS movement score was 13.8 points; after stimulation of the GPi, this improvement was 9.1 points (p = 0.08). Quality of life did not differ significantly regardless of which nucleus was stimulated. All 12 patients accepted 6 months of stimulation of the STN, but only 7 accepted 6 months of stimulation of the GPi. Among those who rejected stimulation of the GPi, 3 accepted concomitant stimulation of both the STN and GPi for 6 months, resulting in improved quality of life physical and mental scores and BFMDRS movement scores. Among the 4 patients who were rated according to TWSTRS, after 6 months of stimulation of both the STN and GPi, TWSTRS scores improved by 4.7% after stimulation of the GPi and 50.8% after stimulation of the STN (p = 0.08). Conclusions The STN seems to be a well-accepted, safe, and promising stimulation target in the treatment of dystonia, but further studies are necessary before the optimal target can be concluded. Simultaneous stimulation of the STN and GPi should be further investigated. Clinical trial registration no.: KF 01-110/01 (Committees on Biomedical Research Ethics of the Capital Region of Denmark).

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“…The encouraging results with DBS in focal or segmental dystonia (except for severe cervical involvement) reported in case series have yet to be confirmed in larger studies. Beneficial effects have also been reported in axial dystonia,65 limb dystonia63 66 and hip dystonia 67…”

Section: Literature Analysis According To the Expected Outcomementioning

confidence: 87%

Deep brain stimulation for dystonia

Vidailhet

Jutras

Grabli

et al. 2012

Journal of Neurology, Neurosurgery & Psychiatry

147

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The few controlled studies that have been carried out have shown that bilateral internal globus pallidum stimulation is a safe and long-term effective treatment for hyperkinetic disorders. However, most recent published data on deep brain stimulation (DBS) for dystonia, applied to different targets and patients, are still mainly from uncontrolled case reports (especially for secondary dystonia). This precludes clear determination of the efficacy of this procedure and the choice of the 'good' target for the 'good' patient. We performed a literature analysis on DBS for dystonia according to the expected outcome. We separated those with good evidence of favourable outcome from those with less predictable outcome. In the former group, we review the main results for primary dystonia (generalised/focal) and highlight recent data on myoclonus-dystonia and tardive dystonia (as they share, with primary dystonia, a marked beneficial effect from pallidal stimulation with good risk/ benefit ratio). In the latter group, poor or variable results have been obtained for secondary dystonia (with a focus on heredodegenerative and metabolic disorders). From this overview, the main results and limits for each subgroup of patients that may help in the selection of dystonic patients who will benefit from DBS are discussed.

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Chronic Deep Brain Stimulation for Segmental Dystonia

Cited by 60 publications

References 34 publications

Deep brain stimulation for camptocormia in dystonia and Parkinson’s disease

Deep brain stimulation for camptocormia in dystonia and Parkinson’s disease

A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia

Deep brain stimulation for dystonia

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