Health-related quality of life in segmental dystonia is improved by bilateral pallidal stimulation

Blahak, Christian; Wöhrle, Johannes C.; Capelle, Hans‐Holger; Bäzner, Hansjörg; Grips, Eva; Weigel, Ralf; Kekelia, Kety; Krauss, Joachim K.

doi:10.1007/s00415-008-0614-3

Cited by 41 publications

(37 citation statements)

References 19 publications

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“…In our group of segmental dystonia patients, we demonstrated a sustained reduction in movement scores in 2 scheduled follow-up examinations. This effect also translated into better quality of life as reflected by marked benefit in the ratings of the SF-36 questionnaire, as reported previously [11] . Our results are comparable to those of the multicenter GPi DBS study in generalized and segmental dystonia, which included sham stimulation for 3 months and an open follow-up period of 6 months [9] .…”

Section: Discussionsupporting

confidence: 54%

“…1 have previously been published as a case report [8] . The effects on quality of life, as assessed by the SF-36, and the differential patterns of recurrence of dystonia after withdrawal of electrical stimulation for a subset of patients have also been reported elsewhere [11,12] . Postoperative short-term follow-up was obtained at a mean of 7 8 1.7 months (FU1, range 4-10 months) and long-term follow-up at a mean of 16.4 8 3.1 months (FU2, range 11-21 months).…”

Section: Methodsmentioning

confidence: 99%

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Chronic Deep Brain Stimulation for Segmental Dystonia

Woehrle

Blahak²,

Kekelia³

et al. 2009

Stereotact Funct Neurosurg

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Fourteen consecutive patients with segmental dystonia underwent chronic deep brain stimulation (DBS) surgery in the frame of a prospective study protocol. Twelve patients received chronic pallidal stimulation, while 2 patients with prominent dystonic tremor received chronic thalamic ventrointermediate nucleus stimulation. Twelve patients had primary dystonia, and 2 patients secondary dystonia. The Burke-Fahn-Marsden dystonia rating scale (BFM motor) showed a mean relative improvement of 57.3% at the first follow-up (FU1, mean 7 months) and 57.8% at the second follow-up (FU2, mean 16 months). The mean BFM scores were 34.9 ± 17.7 preoperatively, 14.9 ± 11.7 at FU1, and 14.8 ± 10.3 at FU2. Scores of the disability subscale improved by 43% at FU1 and 36% at FU2. Improvement was comparatively less in those patients with secondary dystonia. Dysarthria was a limitation of DBS in 4 patients when using high voltage. Overall, chronic DBS is a very effective treatment option for medically refractory segmental dystonia.

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Section: Discussionsupporting

confidence: 54%

Section: Methodsmentioning

confidence: 99%

Chronic Deep Brain Stimulation for Segmental Dystonia

Woehrle

Blahak²,

Kekelia³

et al. 2009

Stereotact Funct Neurosurg

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“…It has been shown to improve motor symptoms and quality of life in both primary generalized dystonia [3,4] and segmental dystonia [4,5] .…”

Section: Introductionmentioning

confidence: 99%

Less Is More: Adaptation of Voltage after Battery Replacement in Deep Brain Stimulation for Dystonia

Blahak

Capelle

Bäzner

et al. 2010

Stereotact Funct Neurosurg

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Background: To maintain the efficacy of deep brain stimulation (DBS) on dystonic symptoms, slight incremental increase in voltage may be necessary over years after a steady state has been reached following the initial programming of optimal settings. So far however, no data are available regarding the adjustment of voltage after implantable pulse generator (IPG) replacement to achieve sustained optimal control of dystonia with the least side effects. Methods: We analyzed stimulation settings before and after IPG replacement for battery depletion (n = 61) in 18 patients with chronic DBS of the globus pallidus internus or the ventral intermediate nucleus of the thalamus for dystonia. Results: The stimulation intensity could be significantly reduced by 24.8% after IPG replacement. The amount of voltage reduction was equal between bipolar and monopolar stimulation modes (24.9 vs. 24.3%, p = 0.89) and significantly correlated with the magnitude of stimulation intensity before IPG replacement (ρ = 0.429, p = 0.001). Conclusions: After IPG replacement, in patients with DBS for segmental dystonia the voltage can be reduced by approximately 25%. This phenomenon might be explained by a gradual decrease in the electrical energy effectively delivered by the IPG in the course of the lifetime of the battery or neuroplastic processes in particular in the period around battery replacement.

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“…Bei dystonen Tremores konnten bei einigen Patienten ebenfalls bes− sere Ergebnisse mit der thalamischen Stimulation als mit der pallidalen Stimulation erzielt werden [23]. Dies zeigte sich so− wohl bei einer Patientin mit einem dystonen Rumpftremor als auch bei einer Patientin mit dystonem Kopftremor auch wäh− rend der Nachbeobachtung [29]. Alternative chronische Stimulation.…”

Section: Multiple Zielpunkteunclassified

“…Insbesonders bleibt hier unkar, ob bei einem individuellen Patienten die Stimulation thalamischer oder pallidaler Zielpunkte vorteilhafter ist. Nach vorläufigen Er− gebnissen profitieren manche Patienten besser von einer chroni− schen Pallidumstimulation, wohingegen andere Patienten ins− besonders solche mit phasischen dystonen Bewegungen oder dystonen Tremores auch im Langzeitverlauf besser von einer thalamischen Stimulation profitieren [23,29]. Selbst nach einem Zeitraum von mehreren Jahren kann der Wechsel des Zielpunk− tes noch sinnvoll sein [30].…”

Section: Multiple Zielpunkteunclassified