Subthalamic nucleus deep brain stimulation in primary cervical dystonia

Ostrem, Jill L.; Racine, Caroline A.; Glass, Graham A.; Grace, Jamie; Volz, Monica; Heath, Susan; Starr, Philip A.

doi:10.1212/wnl.0b013e31820f2e4f

Cited by 213 publications

(158 citation statements)

References 29 publications

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“…Lesser and inconsistent benefit is seen in dystonia secondary to structural brain damage [255]. DBS at other locations, particularly the STN, has also been found in pilot studies to be effective for isolated dystonia [256][257][258][259][260][261][262]. Compared with GPi DBS, STN DBS may offer the advantage of more rapid improvement for dystonia and reduced stimulation parameters [257].…”

Section: Use Of Dbs For Dystoniamentioning

confidence: 99%

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Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

2016

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Deep brain stimulation (DBS) is highly effective for both hypo-and hyperkinetic movement disorders of basal ganglia origin. The clinical use of DBS is, in part, empiric, based on the experience with prior surgical ablative therapies for these disorders, and, in part, driven by scientific discoveries made decades ago. In this review, we consider anatomical and functional concepts of the basal ganglia relevant to our understanding of DBS mechanisms, as well as our current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson's disease and dystonia. Finally, we discuss the proposed mechanism(s) of action of DBS in restoring function in patients with movement disorders. The signs and symptoms of the various disorders appear to result from signature disordered activity in the basal ganglia output, which disrupts the activity in thalamocortical and brainstem networks. The available evidence suggests that the effects of DBS are strongly dependent on targeting sensorimotor portions of specific nodes of the basal gangliathalamocortical motor circuit, that is, the subthalamic nucleus and the internal segment of the globus pallidus. There is little evidence to suggest that DBS in patients with movement disorders restores normal basal ganglia functions (e.g., their role in movement or reinforcement learning). Instead, it appears that high-frequency DBS replaces the abnormal basal ganglia output with a more tolerable pattern, which helps to restore the functionality of downstream networks.

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Section: Use Of Dbs For Dystoniamentioning

confidence: 99%

“…At the other end of the time spectrum, the effects of GPi DBS for generalized dystonia may take days to begin and months to reach maximum effect, suggesting that short-and long-term plasticity may play a role [261]. Movementinduced limb dystonia responds more rapidly than fixed postural dystonia.…”

Section: Time Course Of Responsesmentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

2016

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“…Bilateral STN DBS improved primary cervical dystonia with an efficacy comparable to that of GPi DBS (Ostrem et al, 2011). Improvements in secondary dystonia such as neurodegeneration with brain iron accumulation (NBIA) also have been reported (Ge et al, 2011;Zhang et al, 2006).…”

Section: Target Selectionmentioning

confidence: 91%

“…Improvements in secondary dystonia such as neurodegeneration with brain iron accumulation (NBIA) also have been reported (Ge et al, 2011;Zhang et al, 2006). Moreover, it has been claimed that STN is a better target than GPi for segmental dystonia because stimulation-related adverse effects such as bradykinesia, which has been repeatedly reported in GPi DBS, does not occur with STN DBS (Ostrem et al, 2011). However, STN is still a novel target for dystonia and further studies are needed to see whether STN DBS is an effective and safe therapy for dystonia.…”

Section: Target Selectionmentioning

confidence: 99%

Dystonia and DBS: The Jury Arrives

Kim¹,

Jeon²

2012

Dystonia - The Many Facets

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“…For example, the Vim nucleus of the thalamus has been reported to be effective for patients with dystonic tremor, although in small numbers (~30 cases) [82]. The subthalamic nucleus (STN) has been studied as an alternative target for primary and tardive dystonia [83][84][85][86]. Most of these studies have included small numbers of patients, that is, fewer than 10 patients.…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Treatment of Dystonia

Thenganatt

Jankovic

2014

Neurotherapeutics

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Selecting the appropriate treatment for dystonia begins with proper classification of disease based on age, distribution, and underlying etiology. The therapies available for dystonia include oral medications, botulinum toxin, and surgical procedures. Oral medications are generally reserved for generalized and segmental dystonia. Botulinum toxin revolutionized the treatment of focal dystonia when it was introduced for therapeutic purposes in the 1980s. Surgical procedures are available for medication-refractory dystonia, markedly affecting an individual's quality of life.

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Subthalamic nucleus deep brain stimulation in primary cervical dystonia

Abstract: This study provides Class III evidence that bilateral subthalamic nucleus deep brain stimulation results in significant improvement in cervical dystonia without bradykinetic side effects.

Cited by 213 publications

References 29 publications

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

Dystonia and DBS: The Jury Arrives

Treatment of Dystonia

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