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Montiel M, Fasano A. Dystonia and parkinsonism: Not an easy combo. Parkinsonism Relat Disord 2024; 123:106009. [PMID: 38233325 DOI: 10.1016/j.parkreldis.2024.106009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Marcela Montiel
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Neuroscience, Toronto, Ontario, Canada.
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2
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Courtin E, Poblete NH, Clot F, Guehl D, Burbaud P. Late-onset parkinsonism in a patient with a novel frameshift THAP1 variant. Parkinsonism Relat Disord 2024; 123:105900. [PMID: 37945392 DOI: 10.1016/j.parkreldis.2023.105900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Edouard Courtin
- Department of Clinical Neurophysiology, University Hospital, Bordeaux, France; Institut des maladies neurodégénératives, Université de Bordeaux, CNRS, UMR, 5293, Bordeaux, France.
| | | | - Fabienne Clot
- Department of Medical Genetics, Molecular and Cellular Neurogenetics Functional Unit, AP-HP Sorbonne University Pitié-Salpêtrière Hospitals, Paris, France
| | - Dominique Guehl
- Department of Clinical Neurophysiology, University Hospital, Bordeaux, France; Institut des maladies neurodégénératives, Université de Bordeaux, CNRS, UMR, 5293, Bordeaux, France
| | - Pierre Burbaud
- Department of Clinical Neurophysiology, University Hospital, Bordeaux, France; Institut des maladies neurodégénératives, Université de Bordeaux, CNRS, UMR, 5293, Bordeaux, France
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3
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Honkanen EA, Rönkä J, Pekkonen E, Aaltonen J, Koivu M, Eskola O, Eldebakey H, Volkmann J, Kaasinen V, Reich MM, Joutsa J. GPi-DBS-induced brain metabolic activation in cervical dystonia. J Neurol Neurosurg Psychiatry 2024; 95:300-308. [PMID: 37758453 DOI: 10.1136/jnnp-2023-331668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the globus pallidus interna (GPi) is a highly efficacious treatment for cervical dystonia, but its mechanism of action is not fully understood. Here, we investigate the brain metabolic effects of GPi-DBS in cervical dystonia. METHODS Eleven patients with GPi-DBS underwent brain 18F-fluorodeoxyglucose positron emission tomography imaging during stimulation on and off. Changes in regional brain glucose metabolism were investigated at the active contact location and across the whole brain. Changes in motor symptom severity were quantified using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), executive function using trail making test (TMT) and parkinsonism using Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS The mean (SD) best therapeutic response to DBS during the treatment was 81 (22)%. The TWSTRS score was 3.2 (3.9) points lower DBS on compared with off (p=0.02). At the stimulation site, stimulation was associated with increased metabolism, which correlated with DBS stimulation amplitude (r=0.70, p=0.03) but not with changes in motor symptom severity (p>0.9). In the whole brain analysis, stimulation increased metabolism in the GPi, subthalamic nucleus, putamen, primary sensorimotor cortex (PFDR<0.05). Acute improvement in TWSTRS correlated with metabolic activation in the sensorimotor cortex and overall treatment response in the supplementary motor area. Worsening of TMT-B score was associated with activation of the anterior cingulate cortex and parkinsonism with activation in the putamen. CONCLUSIONS GPi-DBS increases metabolic activity at the stimulation site and sensorimotor network. The clinical benefit and adverse effects are mediated by modulation of specific networks.
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Affiliation(s)
- Emma A Honkanen
- Neurocenter, Turku University Hospital, Turku, Finland
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland
- Department of Neurology, Satasairaala Central Hospital, Pori, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Jaana Rönkä
- Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Juho Aaltonen
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland
| | - Maija Koivu
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Olli Eskola
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Hazem Eldebakey
- Department of Neurology, University Hospital Wurzburg, Wurzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Wurzburg, Wurzburg, Germany
| | - Valtteri Kaasinen
- Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Martin M Reich
- Department of Neurology, University Hospital Wurzburg, Wurzburg, Germany
| | - Juho Joutsa
- Neurocenter, Turku University Hospital, Turku, Finland
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
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4
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Fischer P, Piña-Fuentes D, Kassavetis P, Sadnicka A. Physiology of dystonia: Human studies. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:137-162. [PMID: 37482391 DOI: 10.1016/bs.irn.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
In this chapter, we discuss neurophysiological techniques that have been used in the study of dystonia. We examine traditional disease models such as inhibition and excessive plasticity and review the evidence that these play a causal role in pathophysiology. We then review the evidence for sensory and peripheral influences within pathophysiology and look at an emergent literature that tries to probe how oscillatory brain activity may be linked to dystonia pathophysiology.
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Affiliation(s)
- Petra Fischer
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, Bristol, United Kingdom
| | - Dan Piña-Fuentes
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, The Netherlands; Department of Neurology, OLVG, Amsterdam, The Netherlands
| | | | - Anna Sadnicka
- Motor Control and Movement Disorders Group, St George's University of London, London, United Kingdom; Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
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5
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Lofredi R, Scheller U, Mindermann A, Feldmann LK, Krauss JK, Saryyeva A, Schneider GH, Kühn AA. Pallidal Beta Activity Is Linked to Stimulation-Induced Slowness in Dystonia. Mov Disord 2023. [PMID: 36807626 DOI: 10.1002/mds.29347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Pallidal deep brain stimulation (DBS) effectively alleviates symptoms in dystonia patients, but may induce movement slowness as a side-effect. In Parkinson's disease, hypokinetic symptoms have been associated with increased beta oscillations (13-30 Hz). We hypothesize that this pattern is symptom-specific, thus accompanying DBS-induced slowness in dystonia. METHODS In 6 dystonia patients, pallidal rest recordings with a sensing-enabled DBS device were performed and tapping speed was assessed using marker-less pose estimation over 5 time points following cessation of DBS. RESULTS After cessation of pallidal stimulation, movement speed increased over time (P < 0.01). A linear mixed-effects model revealed that pallidal beta activity explained 77% of the variance in movement speed across patients (P = 0.01). CONCLUSIONS The association between beta oscillations and slowness across disease entities provides further evidence for symptom-specific oscillatory patterns in the motor circuit. Our findings might help DBS therapy improvements, as DBS-devices able to adapt to beta oscillations are already commercially available. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Roxanne Lofredi
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Ute Scheller
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Aurika Mindermann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lucia K Feldmann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Exzellenzcluster - NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
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6
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Swinnen B, Beudel M, Schuurman P, de Bie R. Parkinsonism in GPi‐DBS for dystonia; when to suspect degenerative parkinsonism? Mov Disord Clin Pract 2022; 9:990-991. [PMID: 36247904 PMCID: PMC9547129 DOI: 10.1002/mdc3.13552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- B.E.K.S. Swinnen
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9 Amsterdam The Netherlands
| | - M. Beudel
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9 Amsterdam The Netherlands
| | - P.R. Schuurman
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9 Amsterdam The Netherlands
| | - R.M.A. de Bie
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9 Amsterdam The Netherlands
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7
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Deep brain stimulation in dystonia: factors contributing to variability in outcome in short and long term follow-up. Curr Opin Neurol 2022; 35:510-517. [PMID: 35787538 DOI: 10.1097/wco.0000000000001072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Deep brain stimulation (DBS) is currently the most effective treatment for medically refractory dystonia with globus pallidus internus (GPi) usually the preferred target. Despite the overall success of DBS in dystonia, there remains variability in treatment outcome in both short and long-term follow-up, due to various factors. Factors contributing to variability in outcome comprise 'Dystonia Related' including dystonia classification, semiology, duration, body distribution, orthopaedic deformity, aetiology and genetic cause. The majority of these factors are identifiable from clinical assessment, brain MRI and genetic testing, and therefore merit careful preoperative consideration. 'DBS related' factors include brain target, accuracy of lead placement, stimulation parameters, time allowed for response, neurostimulation technology employed and DBS induced side-effects. In this review, factors contributing to variability in short and long-term dystonia DBS outcome are reviewed and discussed. RECENT FINDINGS The recognition of differential DBS benefit in monogenic dystonia, increasing experience with subthalamic nucleus (STN) DBS and in DBS for Meige syndrome, elucidation of DBS side effects and novel neurophysiological and imaging techniques to assist in predicting clinical outcome. SUMMARY Improved understanding of factors contributing to variability of DBS outcome in dystonia may assist in patient selection and predicting surgical outcomes.
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8
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Bilateral subthalamic nucleus deep brain stimulation for refractory isolated cervical dystonia. Sci Rep 2022; 12:7678. [PMID: 35538160 PMCID: PMC9090754 DOI: 10.1038/s41598-022-11841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/28/2022] [Indexed: 11/08/2022] Open
Abstract
Subthalamic nucleus (STN) deep brain stimulation (DBS) has been proven to be an alternative target choice for refractory isolated cervical dystonia (CD). However, assessments of its short and long-term safety, efficacy, and sustained effectiveness have been limited to few reports. Here, we evaluated nine consecutive refractory isolated CD patients who underwent bilateral STN DBS and accepted to short and long-term follow-up in this retrospective study. Seven time points were used to see the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores (pre-operation [baseline], 1, 3, 6, 12, 24 months post-operation and last follow-up) to assess improvement of dystonic symptoms. The 36-item Short-Form General Health Survey (SF-36) scores obtained at pre-operation and last follow-up to assess the changes in quality of life. All patients tolerated surgery well and acquired observable clinical benefits from STN DBS therapy. All patients achieved a considerable improvement in quality of life at the last follow-up. The hardware-related adverse events can be tolerated and the stimulation-related adverse events can be ameliorated by programming. Our data support the idea that bilateral STN DBS is a safety and effective method for the treatment of refractory isolated CD, with persistent and remarkable improvement in both movement and quality of life.
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9
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Optimal deep brain stimulation sites and networks for cervical vs. generalized dystonia. Proc Natl Acad Sci U S A 2022; 119:e2114985119. [PMID: 35357970 PMCID: PMC9168456 DOI: 10.1073/pnas.2114985119] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We studied deep brain stimulation effects in two types of dystonia and conclude that different specific connections between the pallidum and thalamus are responsible for optimal treatment effects. Since alternative treatment options for dystonia beyond deep brain stimulation are scarce, our results will be crucial to maximize treatment outcome in this population of patients. Dystonia is a debilitating disease with few treatment options. One effective option is deep brain stimulation (DBS) to the internal pallidum. While cervical and generalized forms of isolated dystonia have been targeted with a common approach to the posterior third of the nucleus, large-scale investigations regarding optimal stimulation sites and potential network effects have not been carried out. Here, we retrospectively studied clinical results following DBS for cervical and generalized dystonia in a multicenter cohort of 80 patients. We model DBS electrode placement based on pre- and postoperative imaging and introduce an approach to map optimal stimulation sites to anatomical space. Second, we investigate which tracts account for optimal clinical improvements, when modulated. Third, we investigate distributed stimulation effects on a whole-brain functional connectome level. Our results show marked differences of optimal stimulation sites that map to the somatotopic structure of the internal pallidum. While modulation of the striatopallidofugal axis of the basal ganglia accounted for optimal treatment of cervical dystonia, modulation of pallidothalamic bundles did so in generalized dystonia. Finally, we show a common multisynaptic network substrate for both phenotypes in the form of connectivity to the cerebellum and somatomotor cortex. Our results suggest a brief divergence of optimal stimulation networks for cervical vs. generalized dystonia within the pallidothalamic loop that merge again on a thalamo-cortical level and share a common whole-brain network.
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10
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Swinnen BEKS, Buijink AW, Piña-Fuentes D, de Bie RMA, Beudel M. Diving into the Subcortex: The Potential of Chronic Subcortical Sensing for Unravelling Basal Ganglia Function and Optimization of Deep Brain STIMULATION. Neuroimage 2022; 254:119147. [PMID: 35346837 DOI: 10.1016/j.neuroimage.2022.119147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Subcortical structures are a relative neurophysiological 'terra incognita' owing to their location within the skull. While perioperative subcortical sensing has been performed for more than 20 years, the neurophysiology of the basal ganglia in the home setting has remained almost unexplored. However, with the recent advent of implantable pulse generators (IPG) that are able to record neural activity, the opportunity to chronically record local field potentials (LFPs) directly from electrodes implanted for deep brain stimulation opens up. This allows for a breakthrough of chronic subcortical sensing into fundamental research and clinical practice. In this review an extensive overview of the current state of subcortical sensing is provided. The widespread potential of chronic subcortical sensing for investigational and clinical use is discussed. Finally, status and future perspectives of the most promising application of chronic subcortical sensing -i.e., adaptive deep brain stimulation (aDBS)- are discussed in the context of movement disorders. The development of aDBS based on both chronic subcortical and cortical sensing has the potential to dramatically change clinical practice and the life of patients with movement disorders. However, several barriers still stand in the way of clinical implementation. Advancements regarding IPG and lead technology, physiomarkers, and aDBS algorithms as well as harnessing artificial intelligence, multimodality and sensing in the naturalistic setting are needed to bring aDBS to clinical practice.
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Affiliation(s)
- Bart E K S Swinnen
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland.
| | - Arthur W Buijink
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
| | - Dan Piña-Fuentes
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
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11
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Horisawa S, Kohara K, Murakami M, Fukui A, Kawamata T, Taira T. Deep Brain Stimulation of the Forel's Field for Dystonia: Preliminary Results. Front Hum Neurosci 2021; 15:768057. [PMID: 34912201 PMCID: PMC8667223 DOI: 10.3389/fnhum.2021.768057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/09/2021] [Indexed: 12/05/2022] Open
Abstract
The field of Forel (FF) is a subthalamic area through which the pallidothalamic tracts originating from the globus pallidus internus (GPi) traverse. The FF was used as a stereotactic surgical target (ablation and stimulation) to treat cervical dystonia in the 1960s and 1970s. Although recent studies have reappraised the ablation and stimulation of the pallidothalamic tract at FF for Parkinson’s disease, the efficacy of deep brain stimulation of FF (FF-DBS) for dystonia has not been well investigated. To confirm the efficacy and stimulation-induced adverse effects of FF-DBS, three consecutive patients with medically refractory dystonia who underwent FF-DBS were analyzed (tongue protrusion dystonia, cranio-cervico-axial dystonia, and hemidystonia). Compared to the Burke-Fahn-Marsden Dystonia Rating Scale-Movement Scale scores before surgery (23.3 ± 12.7), improvements were observed at 1 week (8.3 ± 5.9), 3 months (5.3 ± 5.9), and 6 months (4.7 ± 4.7, p = 0.0282) after surgery. Two patients had stimulation-induced complications, including bradykinesia and postural instability, all well controlled by stimulation adjustments.
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Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Kotaro Kohara
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Masato Murakami
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
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12
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Bohnen NI, Kanel P, Koeppe RA, Sanchez-Catasus CA, Frey KA, Scott P, Constantine GM, Albin RL, Müller MLTM. Regional cerebral cholinergic nerve terminal integrity and cardinal motor features in Parkinson's disease. Brain Commun 2021; 3:fcab109. [PMID: 34704022 PMCID: PMC8196256 DOI: 10.1093/braincomms/fcab109] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 01/21/2023] Open
Abstract
Clinical effects of anti-cholinergic drugs implicate cholinergic systems alterations in the pathophysiology of some cardinal motor impairments in Parkinson’s disease. The topography of affected cholinergic systems deficits and motor domain specificity are poorly understood. Parkinson's disease patients (n = 108) underwent clinical and motor assessment and vesicular acetylcholine transporter [18F]-fluoroethoxybenzovesamicol PET imaging. Volumes-of-interest-based analyses included detailed thalamic and cerebellar parcellations. Successful PET sampling for most of the small-sized parcellations was available in 88 patients. A data-driven approach, stepwise regression using the forward selection method, was used to identify cholinergic brain regions associating with cardinal domain-specific motor ratings. Regressions with motor domain scores for model-selected regions followed by confounder analysis for effects of age of onset, duration of motor disease and levodopa equivalent dose were performed. Among 7 model-derived regions associating with postural instability and gait difficulties domain scores three retained significance in confounder variable analysis: medial geniculate nucleus (standardized β = −0.34, t = −3.78, P = 0.0003), lateral geniculate nucleus (β = −0.32, t = −3.4, P = 0.001) and entorhinal cortex (β = −0.23, t = −2.6, P = 0.011). A sub-analysis of non-episodic postural instability and gait difficulties scores demonstrated significant effects of the medial geniculate nucleus, entorhinal cortex and globus pallidus pars interna. Among 6 tremor domain model-selected regions two regions retained significance in confounder variable analysis: cerebellar vermis section of lobule VIIIb (β = −0.22, t = −2.4, P = 0.021) and the putamen (β = −0.23, t = −2.3, P = 0.024). None of the three model-selected variables for the rigidity domain survived confounder analysis. Two out of the four model-selected regions for the distal limb bradykinesia domain survived confounder analysis: globus pallidus pars externa (β = 0.36, t = 3.9, P = 0.0097) and the paracentral lobule (β = 0.26, t = 2.5, P = 0.013). Emphasizing the utility of a systems-network conception of the pathophysiology of Parkinson's disease cardinal motor features, our results are consistent with specific deficits in basal forebrain corticopetal, peduncupontine-laterodorsal tegmental complex, and medial vestibular nucleus cholinergic pathways, against the background of nigrostriatal dopaminergic deficits, contributing significantly to postural instability, gait difficulties, tremor and distal limb bradykinesia cardinal motor features of Parkinson’s disease. Our results suggest significant and distinct consequences of degeneration of cholinergic peduncupontine-laterodorsal tegmental complex afferents to both segments of the globus pallidus. Non-specific regional cholinergic nerve terminal associations with rigidity scores likely reflect more complex multifactorial signalling mechanisms with smaller contributions from cholinergic pathways.
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Affiliation(s)
- Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA.,Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48105, USA
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA
| | - Carlos A Sanchez-Catasus
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Peter Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Gregory M Constantine
- Department of Mathematics, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Department of Statistics, University of Pittsburgh, Pittsburgh, PA 15260, USA.,The McGowen Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA.,Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48105, USA
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI 48105, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI 48105, USA.,Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48105, USA.,Critical Path Institute, Tucson, AZ 85718, USA
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13
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Sobesky L, Goede L, Odekerken VJJ, Wang Q, Li N, Neudorfer C, Rajamani N, Al-Fatly B, Reich M, Volkmann J, de Bie RMA, Kühn AA, Horn A. Subthalamic and pallidal deep brain stimulation: are we modulating the same network? Brain 2021; 145:251-262. [PMID: 34453827 DOI: 10.1093/brain/awab258] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/05/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
The subthalamic nucleus and internal pallidum are main target sites for deep brain stimulation in Parkinson's disease. Multiple trials that investigated subthalamic versus pallidal stimulation were unable to settle on a definitive optimal target between the two. One reason could be that the effect is mediated via a common functional network. To test this hypothesis, we calculated connectivity profiles seeding from deep brain stimulation electrodes in 94 patients that underwent subthalamic and 28 patients with pallidal treatment based on a normative connectome atlas calculated from 1,000 healthy subjects. In each cohort, we calculated connectivity profiles that were associated with optimal clinical improvements. The two maps showed striking similarity and were able to cross-predict outcomes in the respective other cohort (R = 0.37 at p < 0.001; R = 0.34 at p = 0.032). Next, we calculated an agreement map which retained regions common to both target sites. Crucially, this map was able to explain an additional amount of variance in clinical improvements of either cohort when compared to the maps calculated on the two cohorts alone. Finally, we tested profiles and predictive utility of connectivity maps calculated from different motor symptom subscores with a specific focus on bradykinesia and rigidity. While our study is based on retrospective data and indirect connectivity metrics, it may deliver empirical data to support the hypothesis of a largely overlapping network associated with effective deep brain stimulation in Parkinson's disease irrespective of the specific target.
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Affiliation(s)
- Leon Sobesky
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Lukas Goede
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Vincent J J Odekerken
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Qiang Wang
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Ningfei Li
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Clemens Neudorfer
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Nanditha Rajamani
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Bassam Al-Fatly
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Martin Reich
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
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14
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Mulroy E, Vijiaratnam N, De Roquemaurel A, Bhatia KP, Zrinzo L, Foltynie T, Limousin P. A practical guide to troubleshooting pallidal deep brain stimulation issues in patients with dystonia. Parkinsonism Relat Disord 2021; 87:142-154. [PMID: 34074583 DOI: 10.1016/j.parkreldis.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/18/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
High frequency deep brain stimulation (DBS) of the internal portion of the globus pallidus has, in the last two decades, become a mainstream therapy for the management of medically-refractory dystonia syndromes. Such increasing uptake places an onus on movement disorder physicians to become familiar with this treatment modality, in particular optimal patient selection for the procedure and how to troubleshoot problems relating to sub-optimal efficacy and therapy-related side effects. Deep brain stimulation for dystonic conditions presents some unique challenges. For example, the frequent lack of immediate change in clinical status following stimulation alterations means that programming often relies on personal experience and local practice rather than real-time indicators of efficacy. Further, dystonia is a highly heterogeneous disorder, making the development of unifying guidelines and programming algorithms for DBS in this population difficult. Consequently, physicians may feel less confident in managing DBS for dystonia as compared to other indications e.g. Parkinson's disease. In this review, we integrate our years of personal experience of the programming of DBS systems for dystonia with a critical appraisal of the literature to produce a practical guide for troubleshooting common issues encountered in patients with dystonia treated with DBS, in the hope of improving the care for these patients.
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Affiliation(s)
- Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK.
| | - Nirosen Vijiaratnam
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Alexis De Roquemaurel
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
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15
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Kaelin-Lang A, You H, Burgunder JM, Lönnfors-Weitze T, Loher TJ, Taub E, Isaias IU, Krauss JK, Michael Schüpbach W. Bilateral pallidal stimulation improves cervical dystonia for more than a decade. Parkinsonism Relat Disord 2020; 81:78-81. [DOI: 10.1016/j.parkreldis.2020.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
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16
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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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17
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Weiss D, Schoellmann A, Fox MD, Bohnen NI, Factor SA, Nieuwboer A, Hallett M, Lewis SJG. Freezing of gait: understanding the complexity of an enigmatic phenomenon. Brain 2020; 143:14-30. [PMID: 31647540 DOI: 10.1093/brain/awz314] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022] Open
Abstract
Diverse but complementary methodologies are required to uncover the complex determinants and pathophysiology of freezing of gait. To develop future therapeutic avenues, we need a deeper understanding of the disseminated functional-anatomic network and its temporally associated dynamic processes. In this targeted review, we will summarize the latest advances across multiple methodological domains including clinical phenomenology, neurogenetics, multimodal neuroimaging, neurophysiology, and neuromodulation. We found that (i) locomotor network vulnerability is established by structural damage, e.g. from neurodegeneration possibly as result from genetic variability, or to variable degree from brain lesions. This leads to an enhanced network susceptibility, where (ii) modulators can both increase or decrease the threshold to express freezing of gait. Consequent to a threshold decrease, (iii) neuronal integration failure of a multilevel brain network will occur and affect one or numerous nodes and projections of the multilevel network. Finally, (iv) an ultimate pathway might encounter failure of effective motor output and give rise to freezing of gait as clinical endpoint. In conclusion, we derive key questions from this review that challenge this pathophysiological view. We suggest that future research on these questions should lead to improved pathophysiological insight and enhanced therapeutic strategies.
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Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Anna Schoellmann
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Michael D Fox
- Berenson-Allen Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nicolaas I Bohnen
- Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Stewart A Factor
- Department of Neurology, Emory School of Medicine, Atlanta, GA, USA
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
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18
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Neurophysiological insights in dystonia and its response to deep brain stimulation treatment. Exp Brain Res 2020; 238:1645-1657. [PMID: 32638036 PMCID: PMC7413898 DOI: 10.1007/s00221-020-05833-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/11/2020] [Indexed: 01/29/2023]
Abstract
Dystonia is a movement disorder characterised by involuntary muscle contractions resulting in abnormal movements, postures and tremor. The pathophysiology of dystonia is not fully understood but loss of neuronal inhibition, excessive sensorimotor plasticity and defective sensory processing are thought to contribute to network dysfunction underlying the disorder. Neurophysiology studies have been important in furthering our understanding of dystonia and have provided insights into the mechanism of effective dystonia treatment with pallidal deep brain stimulation. In this article we review neurophysiology studies in dystonia and its treatment with Deep Brain Stimulation, including Transcranial magnetic stimulation studies, studies of reflexes and sensory processing, and oscillatory activity recordings including local field potentials, micro-recordings, EEG and evoked potentials.
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19
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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: 10] [Impact Index Per Article: 2.5] [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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20
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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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21
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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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22
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Mahlknecht P, Kaski D, Georgiev D, Foltynie T, Limousin P. Reply: Pathophysiology of gait disorders induced by bilateral globus pallidus interna stimulation in dystonia. Brain 2019; 143:e4. [DOI: 10.1093/brain/awz357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Philipp Mahlknecht
- Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Diego Kaski
- Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Dejan Georgiev
- Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurology, Medical University Ljubljana, Ljubljana, Slovenia
| | - Thomas Foltynie
- Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Patricia Limousin
- Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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23
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Elkouzi A, Tsuboi T, Burns MR, Eisinger RS, Patel A, Deeb W. Dorsal GPi/GPe Stimulation Induced Dyskinesia in a Patient with Parkinson's Disease. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-685. [PMID: 31565536 PMCID: PMC6744811 DOI: 10.7916/tohm.v0.685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/05/2019] [Indexed: 01/16/2023]
Abstract
Clinical vignette A 68-year-old man with Parkinson’s disease (PD) had bilateral GPi DBS placed for management of his motor fluctuations. He developed stimulation-induced dyskinesia (SID) with left dorsal GPi stimulation. Clinical dilemma What do we know about SID in PD patients with GPi DBS? What are the potential strategies used to maximize the DBS therapeutic benefit and minimize the side effects of stimulation? Clinical solution Avoiding the contact implicated in SID and programming more ventral contacts, using lower voltage, frequency and pulse width and programming in bipolar configuration all appear to help minimize the SID and provide appropriate symptomatic motor control. Gap in knowledge Little is known about SID in patients with PD who had GPi DBS therapy. More studies using volume of tissue activated and diffusion tensor imaging MRI are needed to localize specific tracts in or around the GPi that may be implicated in SID.
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Affiliation(s)
- Ahmad Elkouzi
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Takashi Tsuboi
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Matthew R Burns
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | | | - Amar Patel
- Department of Neurology, Yale school of Medicine, Yale University, New Haven, CT, USA
| | - Wissam Deeb
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
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