Non-motor effects of deep brain stimulation in dystonia: A systematic review

Eggink, Hendriekje; Szlufik, Stanisław; Coenen, Maraike A; Egmond, Martje E van; Moro, Elena; Tijssen, Marina A. J.

doi:10.1016/j.parkreldis.2018.06.024

Cited by 22 publications

(45 citation statements)

References 88 publications

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“…Nevertheless, most studies on dystonia and pain have focused on cervical dystonia and other focal dystonias, with a high prevalence of pain (67%–75%); (Kuyper et al., 2011; Stamelou et al., 2012). In patients with inherited/idiopathic generalized dystonia, a randomized clinical trial with 40 patients showed a reduction in pain (VAS) in on‐DBS patients versus no change in sham‐stimulation (63% vs. 0%) at 3 months, which was maintained at 6 months and 5 years (Eggink et al., 2018; Kupsch et al., 2006; Volkmann et al., 2012).…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that pain amelioration is a considerable driver of postoperative improvements in QoL in dystonic patients (Eggink et al., 2018; Kupsch et al., 2006; Vidailhet et al., 2005). Pain relief after DBS treatment is not thought to be simply due to the alleviation of motor symptoms (Eggink et al., 2018) and could be due to increases in nociceptive thresholds, such as described in Parkinson's disease (PD), or instead, by boosting top‐down pain modulatory/inhibitory systems (Cury et al., 2016). DBS is also thought to modify cortical plasticity, an effect that may relate to dystonia overall improvement (Ashkan et al., 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Deep brain stimulation (DBS) targeting the globus pallidus internus (GPi) is the first‐line treatment for refractory dystonia (Kupsch et al., 2006; Vidailhet et al., 2005), improving motor symptoms by 43%–65% (Cury et al., 2018) together with pain improvement. It has been suggested that pain amelioration is a considerable driver of postoperative improvements in QoL in dystonic patients (Eggink et al., 2018; Kupsch et al., 2006; Vidailhet et al., 2005). Pain relief after DBS treatment is not thought to be simply due to the alleviation of motor symptoms (Eggink et al., 2018) and could be due to increases in nociceptive thresholds, such as described in Parkinson's disease (PD), or instead, by boosting top‐down pain modulatory/inhibitory systems (Cury et al., 2016).…”

Section: Introductionmentioning

confidence: 99%

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Abnormal sensory thresholds of dystonic patients are not affected by deep brain stimulation

Listik

Cury

Silva

et al. 2021

European Journal of Pain

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Background Unlike motor symptoms, the effects of deep brain stimulation (DBS) on non‐motor symptoms associated with dystonia remain unknown. Methods The objective of this study was to assess the effects of DBS on evoked experimental pain and cutaneous sensory thresholds in a crossover, double‐blind on/off study and compare these results with those of healthy volunteers (HV). Results Sixteen patients with idiopathic dystonia (39.9 ± 13 years old, n = 14 generalized) with DBS of the globus pallidus internus underwent a battery of quantitative sensory testing and assessment using a pain top‐down modulation system (conditioned pain modulation, CPM). Results for the more and less dystonic body regions were compared in on and off stimulation. The patients' results were compared to age‐ and sex‐matched HV. Descending pain modulation CPM responses in dystonic patients (on‐DBS, 11.8 ± 40.7; off‐DBS, 1.8 ± 22.1) was abnormally low (defective) compared to HV (−15.6 ± 23.5, respectively p = .006 and p = .042). Cold pain threshold and cold hyperalgesia were 54.8% and 95.7% higher in dystonic patients compared to HV. On‐DBS CPM correlated with higher Burke‐Fahn‐Marsden disability score (r = 0.598; p = .014). While sensory and pain thresholds were not affected by DBS on/off condition, pain modulation was abnormal in dystonic patients and tended to be aggravated by DBS. Conclusion The analgesic effects after DBS do not seem to depend on short‐duration changes in cutaneous sensory thresholds in dystonic patients and may be related to changes in the central processing of nociceptive inputs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Abnormal sensory thresholds of dystonic patients are not affected by deep brain stimulation

Listik

Cury

Silva

et al. 2021

European Journal of Pain

View full text Add to dashboard Cite

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“…DBS may improve patients' quality of life and result in desired therapeutic effects such as reduced tremor, dyskinesia, and stiffness in patients with PD (3, 4). However, DBS can also cause adverse events (5) and side effects (e.g., cognitive and emotional changes) (6)(7)(8) in some patients.…”

Section: Introductionmentioning

confidence: 99%

Weight Change After Subthalamic Nucleus Deep Brain Stimulation in Patients With Isolated Dystonia

Lai

et al. 2021

Front. Neurol.

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Purpose: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment method for advanced Parkinson's disease (PD) and isolated dystonia and provides marked improvement of major motor symptoms. In addition, non-motor effects have been reported including weight gain (WG) in patients with PD after STN-DBS. However, it is still unclear whether patients with isolated dystonia also experience WG.Methods: Data from 47 patients with isolated dystonia who underwent bilateral STN-DBS surgery between October 2012 and June 2019 were retrospectively collected. The severity of dystonia was assessed via the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Changes in the body mass index (BMI) and BFMDRS score were analyzed using paired Student's t-tests. Regression analysis was performed to identify factors that affected the BMI after surgery.Results: Postoperative WG was observed in 78.7% of patients. The percentage of overweight and obese patients increased from 25.5% (before STN-DBS) to 48.9% (at the last follow-up). The mean BMI and mean percentage change in BMI increased by 1.32 ± 1.83 kg/m2 (P < 0.001) and 6.28 ± 8.34%, respectively. BMI increased more in female than in male patients. At the last follow-up, BFMDRS movement and disability scores improved by 69.76 ± 33.23% and 65.66 ± 31.41%, respectively (both P < 0.001). The final regression model analysis revealed that sex and preoperative BMI alone were independently associated with BMI change (P < 0.05).Conclusions: STN-DBS is associated with postoperative WG with patients with isolated dystonia. WG is more prominent in female patients and is associated with preoperative weight but not with the efficacy of STN-DBS on motor symptoms.

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“…The globus pallidus internus (GPi) remains the most common target and has been overall utilized more than the subthalamic nucleus (STN) or the thalamus. According to a recent systematic review summarizing the effects of DBS on non-motor symptoms in dystonia patients, GPi DBS reduced dystonia-related pain without significantly impacting anxiety, mood, and cognition [9]. Furthermore, the authors noted a potential dissociation or association between motor and nonmotor response to DBS, which indicates motor assessments alone may not capture the true benefit of DBS.…”

Section: Introductionmentioning

confidence: 99%

Quality of life outcomes after deep brain stimulation in dystonia: A systematic review

Tsuboi

Wong

Okun

et al. 2020

Parkinsonism & Related Disorders

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Non-motor effects of deep brain stimulation in dystonia: A systematic review

Cited by 22 publications

References 88 publications

Abnormal sensory thresholds of dystonic patients are not affected by deep brain stimulation

Abnormal sensory thresholds of dystonic patients are not affected by deep brain stimulation

Weight Change After Subthalamic Nucleus Deep Brain Stimulation in Patients With Isolated Dystonia

Quality of life outcomes after deep brain stimulation in dystonia: A systematic review

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