Pallidal neurostimulation in patients with medication-refractory cervical dystonia: a randomised, sham-controlled trial

Objective: To evaluate changes in the diagnosis of Axis I psychiatric disorders in patients with primary and secondary dystonia after deep brain stimulation (DBS) of the globus pallidus internus (GPi).Methods: Structured Clinical Interviews for the DSM-IV, Axis I psychiatric disorders, were prospectively performed before and after surgery. Diagnoses were made based on DSM-IV criteria. Psychiatric disorders were grouped into 5 categories: mood, anxiety, addiction, obsessivecompulsive disorders, and psychosis. Patients could be stratified to more than one category. Rates for unchanged diagnoses, diagnoses in remission, and new-onset diagnoses after surgery for each category were calculated.Results: Fifty-seven patients with primary and secondary dystonia were included. Mean 6 SD age at surgery and dystonia duration at time of surgery was 50.6 6 13.8 and 19.0 6 13.2 years, respectively. Preoperatively, 37 Axis I diagnoses were made in 25 patients, 43.8% of those presenting with at least 1 Axis I diagnosis (mostly mood and anxiety disorders). Mean 6 SD duration of psychiatric follow-up was 24.4 6 19.6 months. Overall, after surgery no significant changes (p 5 0.16) were found in Axis I diagnoses (23 patients, 40.3%): 27 (73%) unchanged, 10 (27%) in complete remission, and 4 (12.9%) new-onset diagnoses. Conclusions:Our results support the overall psychiatric stability of patients with primary and secondary dystonia treated with GPi DBS. However, considering the high psychiatric morbidity in the dystonia population, psychiatric assessments before and after surgery are strongly recommended.

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“…11,14,39,40 GPi DBS was less effective in secondary dystonia, as expected. 17,30,31,37 Our study has several limitations.…”

Section: Classification Of Evidencesupporting

confidence: 82%

Long-term neuropsychiatric outcomes after pallidal stimulation in primary and secondary dystonia

et al. 2015

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“…Deep brain stimulation (DBS) has become a widely performed surgical procedure for patients with movement disorders such as Parkinson disease, dystonia, and essential tremor [1,2,3]. Accurate lead placement in the intended target is of outmost importance for achieving maximal symptom suppression and minimizing potential stimulation induced side effects [4,5].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Intraoperative Computed Tomography during Deep Brain Stimulation Procedures: Comparison with Postoperative Magnetic Resonance Imaging

Bot

Munckhof

Bakay

et al. 2017

Stereotact Funct Neurosurg

489

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Objective: To determine the accuracy of intraoperative computed tomography (iCT) in localizing deep brain stimulation (DBS) electrodes by comparing this modality with postoperative magnetic resonance imaging (MRI). Background: Optimal lead placement is a critical factor for the outcome of DBS procedures and preferably confirmed during surgery. iCT offers 3-dimensional verification of both microelectrode and lead location during DBS surgery. However, accurate electrode representation on iCT has not been extensively studied. Methods: DBS surgery was performed using the Leksell stereotactic G frame. Stereotactic coordinates of 52 DBS leads were determined on both iCT and postoperative MRI and compared with intended final target coordinates. The resulting absolute differences in X (medial-lateral), Y (anterior-posterior), and Z (dorsal-ventral) coordinates (ΔX, ΔY, and ΔZ) for both modalities were then used to calculate the euclidean distance. Results: Euclidean distances were 2.7 ± 1.1 and 2.5 ± 1.2 mm for MRI and iCT, respectively (p = 0.2). Conclusion: Postoperative MRI and iCT show equivalent DBS lead representation. Intraoperative localization of both microelectrode and DBS lead in stereotactic space enables direct adjustments. Verification of lead placement with postoperative MRI, considered to be the gold standard, is unnecessary.

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“…While most students learned that PD and tremor are common indications for DBS, this was not the case for dystonia, despite the fact that our centre is one of the most active centres in dystonia DBS [26,27,28,29]. With that regard, it is also important to note that self-referrals based on patient-to-patient recommendations are much more common in patients with rare disorders than in those with disorders encountered more frequently.…”

Section: Discussionmentioning

confidence: 96%

What Do Medical Students Know about Deep Brain Stimulation

Wloch¹,

Saryyeva²,

Heissler³

et al. 2017

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) is an established therapy for movement disorders. It is currently under investigation in neuropsychiatric disorders. Neurophobia is a common phenomenon that might have a negative impact in medical education. Little is known about medical students' knowledge about DBS when they enter university and what they learn about it during their medical formation. Methods: A 10-item questionnaire was designed. Questions addressed indications for DBS, costs of DBS, complications, the percentage of Parkinson disease (PD) patients who might profit from DBS, etc. Students at Hannover Medical School were asked to complete the questionnaire in the preclinical study period and in the last year of the study. Results: Comparing the “early group” (204 students) and the “advanced group” (162 students), there was a significant gain of knowledge. More common disorders such as PD and tremor were known to be indications for DBS. Knowledge about the impact of DBS on specific symptoms in PD and about DBS targets was limited in both groups. Conclusions: DBS is partly known among medical students in the preclinical phase with a gain of knowledge during further study. Future studies on this topic addressing general practitioners as neurologists are needed to better understand why knowledge on DBS is still limited.

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Pallidal neurostimulation in patients with medication-refractory cervical dystonia: a randomised, sham-controlled trial

Cited by 290 publications

References 36 publications

Long-term neuropsychiatric outcomes after pallidal stimulation in primary and secondary dystonia

Long-term neuropsychiatric outcomes after pallidal stimulation in primary and secondary dystonia

Accuracy of Intraoperative Computed Tomography during Deep Brain Stimulation Procedures: Comparison with Postoperative Magnetic Resonance Imaging

What Do Medical Students Know about Deep Brain Stimulation

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