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da Silva Lapa JD, Godinho FLF, Teixeira MJ, Listik C, Iglesio RF, Duarte KP, Cury RG. Should the Globus Pallidus Targeting Be Refined in Dystonia? J Neurol Surg A Cent Eur Neurosurg 2021; 83:361-367. [PMID: 34808675 DOI: 10.1055/s-0041-1735856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND STUDY AIMS Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a highly effective therapy for primary generalized and focal dystonias, but therapeutic success is compromised by a nonresponder rate of up to 20%. Variability in electrode placement and in tissue stimulated inside the GPi may explain in part different outcomes among patients. Refinement of the target within the pallidal area could be helpful for surgery planning and clinical outcomes. The objective of this study was to discuss current and potential methodological (somatotopy, neuroimaging, and neurophysiology) aspects that might assist neurosurgical targeting of the GPi, aiming to treat generalized or focal dystonia. METHODS We selected published studies by searching electronic databases and scanning the reference lists for articles that examined the anatomical and electrophysiologic aspects of the GPi in patients with idiopathic/inherited dystonia who underwent functional neurosurgical procedures. RESULTS The sensorimotor sector of the GPi was the best target to treat dystonic symptoms, and was localized at its lateral posteroventral portion. The effective volume of tissue activated (VTA) to treat dystonia had a mean volume of 153 mm3 in the posterior GPi area. Initial tractography studies evaluated the close relation between the electrode localization and pallidothalamic tract to control dystonic symptoms.Regarding the somatotopy, the more ventral, lateral, and posterior areas of the GPi are associated with orofacial and cervical representation. In contrast, the more dorsal, medial, and anterior areas are associated with the lower limbs; between those areas, there is the representation of the upper limb. Excessive pallidal synchronization has a peak at the theta band of 3 to 8 Hz, which might be responsible for generating dystonic symptoms. CONCLUSIONS Somatotopy assessment of posteroventral GPi contributes to target-specific GPi sectors related to segmental body symptoms. Tractography delineates GPi output pathways that might guide electrode implants, and electrophysiology might assist in pointing out areas of excessive theta synchronization. Finally, the identification of oscillatory electrophysiologic features that correlate with symptoms might enable closed-loop approaches in the future.
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Affiliation(s)
- Jorge Dornellys da Silva Lapa
- Neurosurgery Unit, Fundação de Beneficiência Hospital de Cirurgia, Cirurgia, Aracaju, Sergipe, Brazil.,Division of Functional Neurosurgery, Department of Neurology, University of São Paulo, School of Medicine, Sao Paulo, São Paulo, Brazil
| | - Fábio Luiz Franceschi Godinho
- Division of Functional Neurosurgery, Department of Neurology, University of São Paulo, School of Medicine, Sao Paulo, São Paulo, Brazil
| | | | - Clarice Listik
- Movement Disorders Center, Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Ricardo Ferrareto Iglesio
- Division of Functional Neurosurgery, Department of Neurology, University of São Paulo, School of Medicine, Sao Paulo, São Paulo, Brazil
| | - Kleber Paiva Duarte
- Division of Functional Neurosurgery, Department of Neurology, University of São Paulo, School of Medicine, Sao Paulo, São Paulo, Brazil
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of Sao Paulo, Sao Paulo, São Paulo, Brazil
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Crisafulli O, Trompetto C, Puce L, Marinelli L, Costi S, Abbruzzese G, Avanzino L, Pelosin E. Dual task gait deteriorates gait performance in cervical dystonia patients: a pilot study. J Neural Transm (Vienna) 2021; 128:1677-1685. [PMID: 34324056 PMCID: PMC8536592 DOI: 10.1007/s00702-021-02393-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023]
Abstract
Day-to-day walking-related activities frequently involve the simultaneous performance of two or more tasks (i.e., dual task). Dual task ability is influenced by higher order cognitive and cortical control mechanisms. Recently, it has been shown that the concomitant execution of an attention-demanding task affected postural control in subject with cervical dystonia (CD). However, no study has investigated whether dual tasking might deteriorate gait performance in CD patients. To investigate whether adding a concomitant motor and cognitive tasks could affect walking performance in CD subjects.17 CD patients and 19 healthy subjects (HS) participated in this pilot case–control study. Gait performance was evaluated during four walking tasks: usual, fast, cognitive dual task and obstacle negotiation. Spatiotemporal parameters, dual-task cost and coefficients of variability (CV%) were measured by GaitRite® and were used to detect differences between groups. Balance performance was also assessed with Mini-BEST and Four Step Square tests. In CD participants, correlation analysis was computed between gait parameters and clinical data. Significant differences in complex gait and balance performance were found between groups. CD patients showed lower speed, longer stance time and higher CV% and dual-task cost compared to HS. In CD, altered gait parameters correlated with balance performance and were not associated with clinical features of CD. Our findings suggest that complex walking performance is impaired in patients with CD and that balance and gait deficits might be related
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Affiliation(s)
- Oscar Crisafulli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Stefania Costi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Laura Avanzino
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy.
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
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Rahimpour S, Gaztanaga W, Yadav AP, Chang SJ, Krucoff MO, Cajigas I, Turner DA, Wang DD. Freezing of Gait in Parkinson's Disease: Invasive and Noninvasive Neuromodulation. Neuromodulation 2021; 24:829-842. [PMID: 33368872 PMCID: PMC8233405 DOI: 10.1111/ner.13347] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Freezing of gait (FoG) is one of the most disabling yet poorly understood symptoms of Parkinson's disease (PD). FoG is an episodic gait pattern characterized by the inability to step that occurs on initiation or turning while walking, particularly with perception of tight surroundings. This phenomenon impairs balance, increases falls, and reduces the quality of life. MATERIALS AND METHODS Clinical-anatomical correlations, electrophysiology, and functional imaging have generated several mechanistic hypotheses, ranging from the most distal (abnormal central pattern generators of the spinal cord) to the most proximal (frontal executive dysfunction). Here, we review the neuroanatomy and pathophysiology of gait initiation in the context of FoG, and we discuss targets of central nervous system neuromodulation and their outcomes so far. The PubMed database was searched using these key words: neuromodulation, freezing of gait, Parkinson's disease, and gait disorders. CONCLUSION Despite these investigations, the pathogenesis of this process remains poorly understood. The evidence presented in this review suggests FoG to be a heterogenous phenomenon without a single unifying pathologic target. Future studies rigorously assessing targets as well as multimodal approaches will be essential to define the next generation of therapeutic treatments.
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Affiliation(s)
- Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Wendy Gaztanaga
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amol P. Yadav
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stephano J. Chang
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Max O. Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
- Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Iahn Cajigas
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dennis A. Turner
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
- Departments of Neurobiology and Biomedical Engineering, Duke University, Durham, NC, USA
| | - Doris D. Wang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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Tsuboi T, Charbel M, Peterside DT, Rana M, Elkouzi A, Deeb W, Ramirez‐Zamora A, Lemos Melo Lobo Jofili Lopes J, Almeida L, Zeilman PR, Eisinger RS, Foote KD, Okromelidze L, Grewal SS, Okun MS, Middlebrooks EH. Pallidal Connectivity Profiling of Stimulation‐Induced Dyskinesia in Parkinson's Disease. Mov Disord 2020; 36:380-388. [DOI: 10.1002/mds.28324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Takashi Tsuboi
- Department of Neurology Norman Fixel Institute for Neurological Diseases, University of Florida Gainesville Florida USA
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Marc Charbel
- J. Crayton Pruitt Family Department of Biomedical Engineering University of Florida Gainesville Florida USA
| | - David T. Peterside
- Department of Biological Engineering University of Florida Gainesville Florida USA
| | - Mohit Rana
- Institute of Medical Psychology and Behavioural Neurobiology University of Tübingen Tübingen Germany
| | - Ahmad Elkouzi
- Department of Neurology Southern Illinois University School of Medicine Springfield Illinois USA
| | - Wissam Deeb
- Department of Neurology Norman Fixel Institute for Neurological Diseases, University of Florida Gainesville Florida USA
| | - Adolfo Ramirez‐Zamora
- Department of Neurology Norman Fixel Institute for Neurological Diseases, University of Florida Gainesville Florida USA
| | | | - Leonardo Almeida
- Department of Neurology Norman Fixel Institute for Neurological Diseases, University of Florida Gainesville Florida USA
| | - Pamela R. Zeilman
- Department of Neurology Norman Fixel Institute for Neurological Diseases, University of Florida Gainesville Florida USA
| | - Robert S. Eisinger
- Department of Neurology Norman Fixel Institute for Neurological Diseases, University of Florida Gainesville Florida USA
| | - Kelly D. Foote
- Department of Neurosurgery Norman Fixel Institute for Neurological Diseases, University of Florida Gainesville Florida USA
| | | | | | - Michael S. Okun
- Department of Neurology Norman Fixel Institute for Neurological Diseases, University of Florida Gainesville Florida USA
| | - Erik H. Middlebrooks
- Department of Radiology Mayo Clinic Jacksonville Florida USA
- Department of Neurosurgery Mayo Clinic Jacksonville Florida USA
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Wiest C, Tinkhauser G, Pogosyan A, Bange M, Muthuraman M, Groppa S, Baig F, Mostofi A, Pereira EA, Tan H, Brown P, Torrecillos F. Local field potential activity dynamics in response to deep brain stimulation of the subthalamic nucleus in Parkinson's disease. Neurobiol Dis 2020; 143:105019. [PMID: 32681881 PMCID: PMC7115855 DOI: 10.1016/j.nbd.2020.105019] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/17/2020] [Accepted: 07/11/2020] [Indexed: 02/06/2023] Open
Abstract
Local field potentials (LFPs) may afford insight into the mechanisms of action of deep brain stimulation (DBS) and potential feedback signals for adaptive DBS. In Parkinson's disease (PD) DBS of the subthalamic nucleus (STN) suppresses spontaneous activity in the beta band and drives evoked resonant neural activity (ERNA). Here, we investigate how STN LFP activities change over time following the onset and offset of DBS. To this end we recorded LFPs from the STN in 14 PD patients during long (mean: 181.2 s) and short (14.2 s) blocks of continuous stimulation at 130 Hz. LFP activities were evaluated in the temporal and spectral domains. During long stimulation blocks, the frequency and amplitude of the ERNA decreased before reaching a steady state after ~70 s. Maximal ERNA amplitudes diminished over repeated stimulation blocks. Upon DBS cessation, the ERNA was revealed as an under-damped oscillation, and was more marked and lasted longer after short duration stimulation blocks. In contrast, activity in the beta band suppressed within 0.5 s of continuous DBS onset and drifted less over time. Spontaneous activity was also suppressed in the low gamma band, suggesting that the effects of high frequency stimulation on spontaneous oscillations may not be selective for pathological beta activity. High frequency oscillations were present in only six STN recordings before stimulation onset and their frequency was depressed by stimulation. The different dynamics of the ERNA and beta activity with stimulation imply different DBS mechanisms and may impact how these activities may be used in adaptive feedback.
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Affiliation(s)
- C Wiest
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - G Tinkhauser
- Department of Neurology, Bern University Hospital, Bern, Switzerland
| | - A Pogosyan
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - M Bange
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Mainz University Hospital, Mainz, Germany
| | - M Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Mainz University Hospital, Mainz, Germany
| | - S Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Mainz University Hospital, Mainz, Germany
| | - F Baig
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK; Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - A Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - E A Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - H Tan
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - P Brown
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - F Torrecillos
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
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Tsuboi T, Au KLK, Deeb W, Almeida L, Foote KD, Okun MS, Ramirez-Zamora A. Motor outcomes and adverse effects of deep brain stimulation for dystonic tremor: A systematic review. Parkinsonism Relat Disord 2020; 76:32-41. [PMID: 32559631 DOI: 10.1016/j.parkreldis.2020.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/13/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022]
Abstract
Dystonic tremor (DT) is defined as the tremor in body parts affected by dystonia. Although deep brain stimulation (DBS) has been used to manage medically-refractory DT patients, its efficacy has not been well established. The objective of this study is to provide an up-to-date systematic review of DBS outcomes for DT patients. We conducted a literature search using Medline, Embase, and Cochrane Library databases in February 2020 according to the PRISMA guidelines. From 858 publications, we identified 30 articles involving 89 DT patients who received DBS of different targets. Thalamic DBS was the most common (n = 39) and improved tremor by 40-50% potentially in the long-term over five years with variable effects on dystonic symptoms. Globus pallidus internus (GPi), subthalamic, and subthalamic nucleus (STN) DBS improved both tremor and dystonic symptoms; however, data were limited. A few studies have reported better tremor and dystonia outcomes with combinations of different targets. Concerning adverse effects, gait/balance disorders, and ataxia seemed to be more common among patients treated with thalamic or subthalamic DBS, whereas parkinsonian adverse effects were observed only in patients treated with subthalamic or GPi DBS. Comparative benefits and limitations of these targets remain unclear because of the lack of randomized controlled trials. In conclusion, DBS of these targets may improve tremor with a variable effect on dystonia with different adverse effect profiles. The shortcomings in the literature include long-term motor outcomes, quality of life outcomes, optimal DBS targeting, and DBS programming strategy.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Ka Loong Kelvin Au
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Wissam Deeb
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Tsuboi T, Wong JK, Almeida L, Hess CW, Wagle Shukla A, Foote KD, Okun MS, Ramirez-Zamora A. A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia. J Neurol 2020; 267:1278-1290. [DOI: 10.1007/s00415-020-09703-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/24/2022]
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Pathophysiology of gait disorders induced by bilateral globus pallidus interna stimulation in dystonia. Brain 2019; 143:e3. [DOI: 10.1093/brain/awz356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
This chapter presents a review of the literature for falls and abnormalities of balance and gait in isolated dystonia syndromes. Balance appears to be relatively preserved in primary and focal dystonias, except when postural abnormalities significantly displace the center of gravity of the body. Gait can be affected by abnormal dystonic movements and limb deformities, and is commonly abnormal in generalized dystonia. Impairment of gait can also be seen in patients with cervical dystonia when it results in abnormal posturing, and severe cases of blepharospasm leading to functional blindness. Gait abnormalities have also been described in dystonia associated with dopa-responsive dystonia (DRD) and Wilson disease. The data on dystonia and falls are scarce but it has been described as one of the main symptoms of DRD. Local field potential recordings point to abnormal synchronization activity in the pallidum as the main pathophysiologic finding. Cerebellar dysfunction has been reported in patients with primary dystonia and some forms of focal dystonia. While contradictory data have been published on the association between vestibular dysfunction and cervical dystonia, abnormal neck proprioception appears to be present in the latter. Treatment of the dystonia can improve balance and gait, as well as reduce the frequency of falls.
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Affiliation(s)
- Pedro Barbosa
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, University College London, London, United Kingdom.
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Mahlknecht P, Georgiev D, Akram H, Brugger F, Vinke S, Zrinzo L, Hariz M, Bhatia KP, Hariz GM, Willeit P, Rothwell JC, Foltynie T, Limousin P. Parkinsonian signs in patients with cervical dystonia treated with pallidal deep brain stimulation. Brain 2018; 141:3023-3034. [DOI: 10.1093/brain/awy217] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Philipp Mahlknecht
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Dejan Georgiev
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurology, Medical University Ljubljana, Ljubljana, Slovenia
| | - Harith Akram
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Florian Brugger
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Saman Vinke
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Gun-Marie Hariz
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Peter Willeit
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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Meoni S, Fraix V, Castrioto A, Benabid AL, Seigneuret E, Vercueil L, Pollak P, Krack P, Chevrier E, Chabardes S, Moro E. Pallidal deep brain stimulation for dystonia: a long term study. J Neurol Neurosurg Psychiatry 2017; 88:960-967. [PMID: 28972096 DOI: 10.1136/jnnp-2016-315504] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 04/27/2017] [Accepted: 08/16/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pallidal deep brain stimulation (globus pallidus internus (GPi) DBS) is the best therapeutic option for disabling isolated idiopathic (IID) and inherited (INH) dystonia. Acquired dystonia (AD) may also benefit from GPi DBS. Efficacy and safety in the long-term remained to be established. OBJECTIVE To retrospectively assess long-term clinical outcomes and safety in dystonic patients who underwent GPi DBS. METHODS Patients were videotaped and assessed preoperatively and postoperatively (1-year and at last available follow-up) using the Burke-Fahn-Marsden Dystonia Rating Scale (motor score (BFMDRS-M); disability score (BFMDRS-D)). RESULTS Sixty-one patients were included (follow-up 7.9±5.9 years; range 1-20.7). In IID and INH (n=37), the BFMDRS-M improved at first (20.4±24.5; p<0.00001) and last (22.2±18.2; p<0.001) follow-ups compared with preoperatively (50.5±28.0). In AD (n=19), the BFMDRS-M ameliorated at 1-year (40.8±26.5; p<0.02) and late follow-ups (44.3±24.3; p<0.04) compared with preoperatively (52.8±24.2). In INH dystonia with other neurological features (n=4) there was no motor benefit. In IID and INH, the BFMDRS-D improved at 1-year (9.5±7.5; p<0.0002) and late follow-ups (10.4±7.8; p<0.016) compared with preoperatively (13.3±6.9). In AD, the BFMDRS-D reduced at 1-year (12.0±8.1; p<0.01) and late follow-ups (12.7 ±6.1; p=0.2) compared with preoperatively (14.35±5.7). Most adverse events were hardware related. CONCLUSIONS GPi DBS is an effective and safe treatment in most patients with dystonia.
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Affiliation(s)
- Sara Meoni
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France.,Division of Neurology, A.O.U.C., University of Florence, Florence, Italy
| | - Valérie Fraix
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France
| | - Anna Castrioto
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France
| | - Alim Louis Benabid
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France
| | - Eric Seigneuret
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France
| | - Laurent Vercueil
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France
| | - Pierre Pollak
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France.,Department of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - Paul Krack
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France.,Department of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - Eric Chevrier
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France
| | - Stephan Chabardes
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France
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Esposito M, Dubbioso R, Peluso S, Picone A, Corrado B, Servodio Iammarone C, Allocca R, Manganelli F, Santoro L, Fasano A. Cervical dystonia patients display subclinical gait changes. Parkinsonism Relat Disord 2017; 43:97-100. [PMID: 28712731 DOI: 10.1016/j.parkreldis.2017.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/28/2017] [Accepted: 07/09/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Gait disorders in cervical dystonia (CD) are reported in patients under DBS or in severe cases complicated with spinal deformities. OBJECTIVE to assess walking motor pattern in CD patients without DBS and not presenting scoliosis. METHODS Computerized gait analysis (CGA) was performed in CD patients, before and after botulinum toxin (BoNT) injections, and in healthy controls (HC). Spatiotemporal (ST) parameters were compared between CD and HC groups. Correlation analysis was conducted between ST parameters and clinical features of CD patients. RESULTS CD patients demonstrated a significant reduction of velocity, stride length, % of swing phase, and dynamic stability index while stride and swing time were increased. No significant effect of BoNT was detected. A significant inverse correlation was found between TWSTRS and stride length. CONCLUSION CD patients may have a slow gait with subclinical evidence. Our data suggest this alteration might be an endophenotipic feature of CD.
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Affiliation(s)
- Marcello Esposito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Silvio Peluso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Antonio Picone
- Orthopedic Surgery Department, Rehabilitation Unit, Federico II University, Naples, Italy
| | - Bruno Corrado
- Orthopedic Surgery Department, Rehabilitation Unit, Federico II University, Naples, Italy
| | | | - Roberto Allocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Italy
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre, The Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada.
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Hypometric anticipatory postural adjustments in dystonia are not affected by deep brain stimulation of globus pallidus internus. Neurosci Lett 2017; 636:151-157. [PMID: 27836806 DOI: 10.1016/j.neulet.2016.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/02/2016] [Accepted: 11/06/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dystonia is a movement disorder with patterned, directional, and often sustained muscle contractions that produce abnormal postures or repetitive movements. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective and safe treatment for medically refractory dystonia. However, recent studies reported gait problems, gait freezing and falls in patients treated with DBS. Because these symptoms may point to deficient gait initiation processes, we systematically assessed the anticipatory postural adjustments (APAs) prior to stepping in dystonia patients with GPi-DBS. METHODS Thirteen patients with focal/segmental dystonia under GPi-DBS and twelve healthy control subjects were included in the study. Data were collected using pressure sensitive sensors and APAs were studied by centre of pressure measures. We compared APAs of both groups and analysed the influence of GPi-DBS on APAs in patients. RESULTS Medio-lateral and antero-posterior COP displacements, total COP path, maximal APA velocity and 1st step length were all smaller in patients for both ON (p=0.006, p=0.018, p=0.002, p=0.016, p=0.04) and OFF (p=0.001, p=0.01, p=0.001, p=0.03, p=0.024) condition compared to healthy subjects. GPi-DBS did not change APA parameters in patients. CONCLUSIONS Observations that APAs are impaired in dystonia and are at the same time not affected by the stimulation current are compatible with the assumption that APAs and dystonic symptoms may rely on distinct networks, possibly within the same cortical and basal ganglia structures. With no effect of stimulation on APAs it is unlikely that this would be a mechanism of impaired balance in the patients after the surgery.
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