Deep Brain Stimulation of the Globus Pallidus Internus for Secondary Dystonia: Clinical Cases and Systematic Review of the Literature Regarding the Effectiveness of Globus Pallidus Internus versus Subthalamic Nucleus

Öztürk, Sait; Temel, Yasin; Aygün, Dursun; Kocabıcak, Ersoy

doi:10.1016/j.wneu.2021.07.070

Cited by 7 publications

(6 citation statements)

References 116 publications

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“…Ten studies of STN DBS in acquired or neurodegenerative dystonia were identified, reporting outcomes in 146 secondary dystonia cases. The mean BFMDRS improvement was 66% (minimum 28%, maximum 98%) with an average follow up of 20 months (67).…”

Section: Studies Directly Comparing Pallidal and Subthalamic Dbs In D...mentioning

confidence: 92%

Subthalamic Nucleus Deep Brain Stimulation for Dystonia: Evidence, Pros and Cons

Kilbane

Ostrem²

2022

Dystonia

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The primary target for deep brain stimulation (DBS) for medication refractory dystonia has traditionally been the globus pallidus internus (GPi), however alternate targets have also been explored with the hope they might offer similar or superior outcomes with less side effects and reduced battery demands. Recent studies have shown comparable outcomes with both pallidal and subthalamic (STN) DBS, although the level of evidence is still superior for the GPi. There may not be an “optimal target” for all dystonia patients, with both targets offering the potential for excellent control of dystonia but more comparison studies are needed. In this review, we will discuss the history, efficacy, as well as target specific benefits and possible side effects of STN DBS for dystonia.

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Section: Studies Directly Comparing Pallidal and Subthalamic Dbs In D...mentioning

confidence: 92%

Subthalamic Nucleus Deep Brain Stimulation for Dystonia: Evidence, Pros and Cons

Kilbane

Ostrem²

2022

Dystonia

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“…The variability in targets identified during inpatient testing supports heterogeneity of the origin of symptoms in this population, and the possibility of future additional targets including anterior globus pallidus internus, substantia nigra reticulata, and the pedunculopontine nucleus. 32 The observed variability in response as measured by the Burke-Fahn-Marsden Dystonia Rating Scale and Barry-Albright Dystonia Scale scores likely reflects both symptomatic and etiologic heterogeneity, as well as limited sensitivity and reliability of these scales in adequately assessing changes in pediatric dystonia. 33 Parents consistently identify quality of life as a significant consideration for proceeding with deep brain stimulation; in this study, 96.7% of parents whose children were treated with the Stereotactic Awake *Preexisting deep brain stimulation leads in GPi prior to patient undergoing staged procedure; in these subjects, the "Pre" BFMDRS and BADS ratings were performed prior to the neuromodulation monitoring unit procedure with GPi stimulation at previously optimized settings.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stereotactic Awake Basal Ganglia Electrophysiological Recording and Stimulation (SABERS): A Novel Staged Procedure for Personalized Targeting of Deep Brain Stimulation in Pediatric Movement and Neuropsychiatric Disorders

Liker,

Sanger,

MacLean

et al. 2024

J Child Neurol

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Selection of targets for deep brain stimulation (DBS) has been based on clinical experience, but inconsistent and unpredictable outcomes have limited its use in patients with heterogeneous or rare disorders. In this large case series, a novel staged procedure for neurophysiological assessment from 8 to 12 temporary depth electrodes is used to select targets for neuromodulation that are tailored to each patient's functional needs. Thirty children and young adults underwent deep brain stimulation target evaluation with the new procedure: Stereotactic Awake Basal ganglia Electrophysiological Recording and Stimulation (SABERS). Testing is performed in an inpatient neuromodulation monitoring unit over 5-7 days, and results guide the decision to proceed and the choice of targets for permanent deep brain stimulation implantation. Results were evaluated 3-6 months postoperatively with the Burke-Fahn-Marsden Dystonia Rating Scale and the Barry-Albright Dystonia Scale. Stereotactic Awake Basal ganglia Electrophysiological Recording and Stimulation testing allowed modulation to be tailored to specific neurologic deficits in a heterogeneous population, including subjects with primary dystonia, secondary dystonia, and Tourette syndrome. All but one subject were implanted with 4 permanent deep brain stimulation leads. Results showed significant improvement on both scales at postoperative follow-up. No significant adverse events occurred. Use of the Stereotactic Awake Basal ganglia Electrophysiological Recording and Stimulation protocol with evaluation in the neuromodulation monitoring unit is feasible and results in significant patient benefit compared with previously published results in these populations. This new technique supports a significant expansion of functional neurosurgery to predict effective stimulation targets in a wide range of disorders of brain function, including those for which the optimal target is not yet known.

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“…54 From the small series available, the results of pallidotomy seem to be comparable with those of DBS in patients with AGD. 17,29,46,[55][56][57] A recent review suggested that change in the motor score of BFMDRS was variable among studies, ranging from a mean percentage reduction of 1.2% to 49.5%. 58 However, it is not possible to compare our results with those from that study because less than 10% of patients were children.…”

Section: Comparison Of Pallidotomy With Dbs In Patients With Generali...mentioning

confidence: 99%

Bilateral pallidotomy for acquired or heredodegenerative generalized dystonia in children

Garg

Singh

Samala

et al. 2022

Neurosurgical Focus

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OBJECTIVE Dystonias are relatively rare disorders characterized by sustained or intermittent muscle contractions causing abnormal movements or postures. Generalized dystonia is a therapeutic challenge because medications are unable to control dystonia adequately in most patients. These patients may be candidates for surgical therapy. The commonly used surgical procedures in these patients are pallidotomy and deep brain stimulation. Limited studies are available on the role of pallidotomy in children with acquired/heredodegenerative generalized dystonia. The objective of this study was to describe the authors’ experience with bilateral pallidotomy in this group of patients. METHODS The authors retrospectively reviewed all pediatric patients (less than 18 years of age) with acquired/heredodegenerative generalized dystonia who underwent bilateral simultaneous pallidotomy at their center between January 2014 and January 2021. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores before and after surgery were recorded. Complications arising after the procedure were recorded as well. RESULTS Ten patients (8 male and 2 female) with a mean (range) age of 11.1 (5–17) years were included in this study. The mean duration between disease onset and surgical intervention was 3.9 years. Two patients presented in status dystonicus. The mean ± SD (range) preoperative BFMDRS score of the patients without status dystonicus (n = 8) was 80 ± 18.9 (59.5–108). The mean ± SD BFMDRS score at the time of discharge from the hospital after surgery was 58.8 ± 37.9. Three patients had more than 20% change in BFMDRS score at the time of discharge from the hospital. The mean improvement was 25.5% at the end of 1 year. Of 5 surviving patients in the non–status dystonicus group, 3 patients had more than 40% change in BFMDRS score while the other 2 patients developed recurrence at the last follow-up (4.5 years). Status dystonicus abated after bilateral pallidotomy in both patients. Permanent bulbar complications were seen in 2 patients. CONCLUSIONS Bilateral pallidotomy may result in clinically significant improvement in children with acquired/heredodegenerative generalized dystonia, although the benefits should be closely weighed against the risk of irreversible bulbar dysfunction. It is a viable option for children in resource-limited settings.

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Deep Brain Stimulation of the Globus Pallidus Internus for Secondary Dystonia: Clinical Cases and Systematic Review of the Literature Regarding the Effectiveness of Globus Pallidus Internus versus Subthalamic Nucleus

Cited by 7 publications

References 116 publications

Subthalamic Nucleus Deep Brain Stimulation for Dystonia: Evidence, Pros and Cons

Subthalamic Nucleus Deep Brain Stimulation for Dystonia: Evidence, Pros and Cons

Stereotactic Awake Basal Ganglia Electrophysiological Recording and Stimulation (SABERS): A Novel Staged Procedure for Personalized Targeting of Deep Brain Stimulation in Pediatric Movement and Neuropsychiatric Disorders

Bilateral pallidotomy for acquired or heredodegenerative generalized dystonia in children

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