Unilateral Pallidal Stimulation in Cervical Dystonia

İşlekel, Sertaç; Zılelı, Mehmet; Zileli, Berna

doi:10.1159/000029736

Cited by 60 publications

(39 citation statements)

References 8 publications

(9 reference statements)

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“…Taken together several groups have described a significant pain reduction and an approximately 50% motor benefit in patients treated for severe cervical dystonia by bilateral pallidal stimulation. [23][24][25] In a patient with Meige syndrome, bilateral pallidal stimulation was able to further improve the condition after staged bilateral thalamotomy performed 10 years before.…”

Section: Treatment Resultsmentioning

confidence: 98%

Deep brain stimulation for dystonia: Patient selection and evaluation

Volkmann

Benecke

2002

Mov Disord.

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Deep brain stimulation (DBS) for dystonia still needs to be considered investigational, because there are no controlled studies for this indication, the optimal target point is uncertain, and long-term effects are unknown. The striking improvement of levodopa-induced dyskinesias in Parkinson's disease by deep brain stimulation of the internal pallidum has encouraged the use of this therapy for generalized and severe segmental dystonia in children and adults. Single case and small cohort studies have reported impressive efficacy of pallidal DBS in patients with primary dystonia, especially DYT1 mutation carriers, but results in secondary dystonia are less conclusive. This article discusses the different factors influencing patient selection for surgical treatment and describes standardized methods and the caveats for clinical documentation of treatment results in dystonia.

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Section: Treatment Resultsmentioning

confidence: 98%

Deep brain stimulation for dystonia: Patient selection and evaluation

Volkmann

Benecke

2002

Mov Disord.

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“…3, 9]. I˙şlekel et al [18] suggested that the DBS target must be the GPi contralateral to the contracted sternocleidomastoid muscle. However, we found that ipsilateral DBS had the greatest beneficial effect in our patient with horizontal torticollis.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Pallidal Stimulation for Cervical Dystonia

Goto¹,

Mita

Ushio³

2002

Stereotact Funct Neurosurg

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We sought to identify optimal paradigms of bilateral globus pallidus internus (GPi) stimulation in 3 subsequent patients with severe cervical dystonia. At low frequency stimulation (50–60 Hz) with wide pulse width (500 µs) and high amplitude (4.5–8.0 V), we observed immediate and consistent improvement of dystonia and dystonia-associated pain. Stimulation of the posteroventral portion of the GPi led to pronounced alleviation of dystonia; stimulation of the anterodorsal portion or at the dorsal border of the GPi resulted in significant worsening of symptoms. The therapeutic benefit obtained by using the optimal stimulation parameters continues and has lasted for at least 1 year in each patient.

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“…Fokale,gegenüber Botulinumtoxin resistente zervikale Dystonien zeigten nach den Ergebnissen anderer Gruppen eine signifikante Schmerzreduktion und eine Verbesserung der Motorik um etwa 50% unter bilateraler Pallidumstimulation [4,26,30], ein bei Meige-Syndrom 10 Jahre zuvor bilateral thalamotomierter Patient wies eine zusätzliche Besserung unter Pallidumstimulation auf [38].…”

Section: Sekundär Generalisierte Dystonienunclassified

Die tiefe Hirnstimulation zur Behandlung von M. Parkinson, Tremor und Dystonie

et al. 2003

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Die tiefe Hirnstimulation stellt eine wirkungsvolle Erweiterung der medikamentösen Behandlung von behindernden motorischen Symptomen bei neurologischen Bewegungsstörungen dar. Die Vorteile gegenüber ablativen stereotaktischen Verfahren liegen in der nur geringen Gewebsschä-digung durch das Einbringen der Stimulationselektroden und der damit prinzipiell gegebenen Reversibilität von unerwünschten Therapieeffekten.Weiterhin kann die Therapie durch Änderung der Stimulationsparameter an den Verlauf der Erkrankung angepasst werden, so dass über Jahre hinaus die Möglichkeit der Therapieoptimierung gegeben ist.Die Hochfrequenzstimulation des Nucleus subthalamicus (STN) und Globus pallidus internus (GPi) bei M. Parkinson, des Nucleus ventralis intermedius thalami (VIM) bei essenziellem Tremor und des GPi bei Dystonien gelten als etablierte Therapieverfahren und führen zu einer messbaren Verbesserung der motorischen Symptome der betroffenen Patienten.Studien zur Erfassung der Einflüsse auf die Lebensqualität sind dringend erforderlich und werden aktuell für M. Parkinson und Dystonien durchgeführt.Die Behandlung des zerebellären Tremors bei multipler Sklerose (MS) durch die tiefe Hirnstimulation gestaltet sich schwieriger, wobei durch strenge Patientenselektion in Einzelfällen eine weitreichende Linderung der motorischen Behinderung erreicht werden kann.Die Datenlage lässt zum gegenwärtigen Zeitpunkt keine Beurteilung des Langzeiteffektes bei MS-Tremor zu, Studien zur Evaluation der chronischen VIM-Stimulation bei dieser Indikation werden dringend benötigt. SchlüsselwörterTiefe Hirnstimulation · Bewegungsstörungen · Tremor · Dystonie · M. Parkinson High-frequency deep brain stimulation in the treatment for Parkinson's disease, tremor and dystonia SummaryHigh-frequency deep brain stimulation (DBS) is a powerful instrument for the treatment of neurological movement disorders. Compared to ablative surgery DBS offers a non-lesional modulation of basal ganglia output, its effects are principally reversible, and it is possible to adapt the therapy to the course of the disease and the individual needs of the patient. DBS of the subthalamic nucleus and internal pallidum for advanced Parkinson's disease, of the nucleus ventrointermedius thalami for essential tremor, and of the internal pallidum in severe dystonia have proven a substantial benefit. However, studies evaluating the influence of DBS on the quality of life, carried out for Parkinson's disease and dystonia,are still pending.The treatment of cerebellar tremor in multiple sclerosis (MS) is more complex and careful patient selection is crucial for a functional benefit beyond mere tremor reduction. The available data do not allow an estimate of the long-term efficacy of DBS on MS tremor and studies dealing with this are urgently required.

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Unilateral Pallidal Stimulation in Cervical Dystonia

Cited by 60 publications

References 8 publications

Deep brain stimulation for dystonia: Patient selection and evaluation

Deep brain stimulation for dystonia: Patient selection and evaluation

Bilateral Pallidal Stimulation for Cervical Dystonia

Die tiefe Hirnstimulation zur Behandlung von M. Parkinson, Tremor und Dystonie

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