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Sobstyl M, Stapińska-Syniec A, Giziński J, Kmieć T, Kupryjaniuk A. Deep brain stimulation hardware-related complications and their management: A single-center retrospective analysis of 65 patients with various dystonic conditions. J Neurol Sci 2019; 407:116513. [PMID: 31678789 DOI: 10.1016/j.jns.2019.116513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/26/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, Poland.
| | - Angelika Stapińska-Syniec
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, Poland
| | - Jakub Giziński
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, Poland
| | - Tomasz Kmieć
- Department of Neurology, Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Anna Kupryjaniuk
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, Poland
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Wu YS, Ni LH, Fan RM, Yao MY. Meta-Regression Analysis of the Long-Term Effects of Pallidal and Subthalamic Deep Brain Stimulation for the Treatment of Isolated Dystonia. World Neurosurg 2019; 129:e409-e416. [PMID: 31146039 DOI: 10.1016/j.wneu.2019.05.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The globus pallidus internus (GPi) and subthalamic nucleus (STN) are therapeutic targets for deep brain stimulation (DBS) in the treatment of isolated dystonia. We conducted a meta-regression analysis on long-term studies of bilateral DBS in the GPi and STN to compare the relative effects of the 2 approaches. METHODS We systematically searched the PubMed, Embase, and Cochrane Controlled Register of Trials databases to identify studies reporting the treatment outcomes of GPi DBS and STN DBS for isolated dystonia. The primary outcome measure was the change in the Burke-Fahn-Marsden dystonia rating scale movement score between the baseline and follow-up evaluations. We performed a regression analysis using a random effects model. RESULTS A total of 42 follow-up evaluations (30 for GPi and 12 for STN) nested in 19 studies (16 of GPi and 3 of STN) were included in our analysis. The results from univariate regression analysis suggested that shorter disease duration and STN stimulation were associated with a greater standardized change in the Burke-Fahn-Marsden dystonia rating scale movement score. On combining the factors into 1 model, only the disease duration remained significant. The regression analysis results of the GPi and STN subgroups revealed more persistent improvement after STN stimulation. CONCLUSIONS A shorter disease duration correlated positively with better DBS outcomes. The STN appeared to be an optimized stimulation target for the treatment of isolated dystonia, although randomized controlled trials are needed to compare the treatment efficacy of GPi DBS and STN DBS.
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Affiliation(s)
- Yi-Song Wu
- Department of Neurology, Xinyang Central Hospital, Xinyang, China.
| | - Lin-Hui Ni
- Department of Neurology, Xinyang Central Hospital, Xinyang, China; Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ru-Meng Fan
- Department of Neurology, Xinyang Central Hospital, Xinyang, China; Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ming-Yang Yao
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Cardiology, Nanyang Central hospital, Nanyang, China
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Jitkritsadakul O, Bhidayasiri R, Kalia SK, Hodaie M, Lozano AM, Fasano A. Systematic review of hardware-related complications of Deep Brain Stimulation: Do new indications pose an increased risk? Brain Stimul 2017; 10:967-976. [DOI: 10.1016/j.brs.2017.07.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/21/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023] Open
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Eddelman D, Wewel J, Wiet RM, Metman LV, Sani S. Deep brain stimulation with a pre-existing cochlear implant: Surgical technique and outcome. Surg Neurol Int 2017; 8:47. [PMID: 28480109 PMCID: PMC5402338 DOI: 10.4103/sni.sni_412_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/03/2017] [Indexed: 11/09/2022] Open
Abstract
Background: Patients with previously implanted cranial devices pose a special challenge in deep brain stimulation (DBS) surgery. We report the implantation of bilateral DBS leads in a patient with a cochlear implant. Technical nuances and long-term interdevice functionality are presented. Case Description: A 70-year-old patient with advancing Parkinson's disease and a previously placed cochlear implant for sensorineural hearing loss was referred for placement of bilateral DBS in the subthalamic nucleus (STN). Prior to DBS, the patient underwent surgical removal of the subgaleal cochlear magnet, followed by stereotactic MRI, frame placement, stereotactic computed tomography (CT), and merging of imaging studies. This technique allowed for successful computational merging, MRI-guided targeting, and lead implantation with acceptable accuracy. Formal testing and programming of both the devices were successful without electrical interference. Conclusion: Successful DBS implantation with high resolution MRI-guided targeting is technically feasible in patients with previously implanted cochlear implants by following proper precautions.
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Affiliation(s)
- Daniel Eddelman
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua Wewel
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - R Mark Wiet
- Department of Otolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Leo V Metman
- Department of Neurology, Rush University Medical Center, Chicago, Illinois, USA
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
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Bergenheim AT, Nordh E, Larsson E, Hariz MI. Selective peripheral denervation for cervical dystonia: long-term follow-up. J Neurol Neurosurg Psychiatry 2015; 86:1307-13. [PMID: 25362089 PMCID: PMC4680147 DOI: 10.1136/jnnp-2014-307959] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 09/29/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE 61 procedures with selective peripheral denervation for cervical dystonia were retrospectively analysed concerning surgical results, pain, quality of life (QoL) and recurrences. METHODS The patients were assessed with the Tsui torticollis scale, Visual Analogue Scale (VAS) for pain and Fugl-Meyer scale for QoL. Evaluations were performed preoperatively, early postoperatively, at 6 months, then at a mean of 42 (13-165) months. All patients underwent electromyogram at baseline, which was repeated in cases who presented with recurrence of symptoms after surgery. RESULTS Six months of follow-up was available for 55 (90%) of the procedures and late follow-up for 34 (56%). The mean score of the Tsui scale was 10 preoperatively. It improved to 4.5 (p<0.001) at 6 months, and 5.3 (p<0.001) at late follow-up. VAS for pain improved from 6.5 preoperatively to 4.2 (p<0.001) at 6 months and 4 (p<0.01) at late follow-up. The Fugl-Meyer score for QoL improved from 43.3 to 46.6 (p<0.05) at 6 months, and to 51.1 (p<0.05) at late follow-up. Major reinnervation and/or change in the dystonic pattern occurred following 29% of the procedures, and led in 26% of patients to reoperation with either additional denervation or pallidal stimulation. CONCLUSIONS Selective peripheral denervation remains a surgical option in the treatment of cervical dystonia when conservative measures fail. Although the majority of patients experience a significant relief of symptoms, there is a substantial risk of reinnervation and/or change in the pattern of the cervical dystonia.
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Affiliation(s)
- A Tommy Bergenheim
- Department of Clinical Neuroscience, Section of Neurosurgery, Umeå University, Umeå, Sweden
| | - Erik Nordh
- Department of Clinical Neuroscience, Section of Neurophysiology, Umeå University, Umeå, Sweden
| | - Eva Larsson
- Department of Clinical Neuroscience, Section of Neurosurgery, Umeå University, Umeå, Sweden
| | - Marwan I Hariz
- Department of Clinical Neuroscience, Section of Neurosurgery, Umeå University, Umeå, Sweden UCL Institute of Neurology, London, UK
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Latini F, Sensi M, Preda F, Cavallo MA. How to avoid trivial mistakes during IPG replacement in patients treated with DBS for movement disorders: technical note from 13-years experience. Int J Neurosci 2014; 125:760-4. [DOI: 10.3109/00207454.2014.984294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lettieri C, Rinaldo S, Devigili G, Pisa F, Mucchiut M, Belgrado E, Mondani M, D'Auria S, Ius T, Skrap M, Eleopra R. Clinical outcome of deep brain stimulation for dystonia: constant-current or constant-voltage stimulation? A non-randomized study. Eur J Neurol 2014; 22:919-26. [DOI: 10.1111/ene.12515] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 05/26/2014] [Indexed: 12/31/2022]
Affiliation(s)
- C. Lettieri
- Neurology Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - S. Rinaldo
- Neurology Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - G. Devigili
- Neurology Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - F. Pisa
- Institute of Hygiene and Clinical Epidemiology; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - M. Mucchiut
- Neurology Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - E. Belgrado
- Neurology Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - M. Mondani
- Neurosurgery Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - S. D'Auria
- Neurosurgery Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - T. Ius
- Neurosurgery Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - M. Skrap
- Neurosurgery Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
| | - R. Eleopra
- Neurology Unit; ‘S. Maria della Misericordia’ University Hospital; Udine Italy
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Chandra SR, Issac TG. Battered woman syndrome: An unusual presentation of pseudodystonia. J Neurosci Rural Pract 2014; 5:189-90. [PMID: 24966567 PMCID: PMC4064194 DOI: 10.4103/0976-3147.131679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudodystonia is the term used to define abnormal postures, which are not due to the disorders of the basal ganglia and is encountered very rarely in clinical practice and often difficult to distinguish from true dystonia syndromes. We report a rare case of a battered woman who was managed as restricted resistant dystonia with pharmacotherapy and intrathecal baclofen and referred for considering deep brain stimulation (DBS). The patient turned out to be a case of pseudodystonia due to bilateral hip dislocation. This was due to assault by a close relative and the history was masked by the patient for more than one and a half years. In a patient with late onset dystonia, who is resistant to the recommended treatment for dystonia along with atypical clinical features and electrophysiological parameters, pseudodystonia should always be considered as a possible diagnosis and evaluated for causes of the same.
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Affiliation(s)
| | - Thomas Gregor Issac
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Thobois S, Danaila T, Polo G, Simon E, Mertens P, Broussolle E. Deep-brain stimulation for dystonia: current indications and future orientations. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.13.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT: Deep-brain stimulation of the internal globus pallidus is a therapeutic option for dystonia. However, the available data are heterogeneous, ranging from single case reports to a few controlled studies. The outcomes are also largely heterogeneous, depending mostly on the etiology of the dystonia. Except for some well-established good indications, such as primary generalized dystonia and tardive dyskinesia, the efficacy of globus pallidus stimulation remains debated for several forms of dystonia. In addition, many issues are still unsolved, such as the best target of stimulation and the interest of simultaneously combining multiple targets of stimulation or not. Finally the efficacy of new strategies of treatment, such as cortical stimulation, remains to be determined. The aim of this review is to cover these different aspects and give an overview of the current indications and future orientations.
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Affiliation(s)
- Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Neurologie C, Université Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, 59 Boulevard Pinel, 69677 Bron, France
| | - Teodor Danaila
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Neurologie C, Université Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, 59 Boulevard Pinel, 69677 Bron, France
| | - Gustavo Polo
- Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Université Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France
| | - Emile Simon
- Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Université Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France
| | - Patrick Mertens
- Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Université Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France
| | - Emmanuel Broussolle
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Neurologie C, Université Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, 59 Boulevard Pinel, 69677 Bron, France
- Centre National de la Recherche Scientifique, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
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Abstract
Selecting the appropriate treatment for dystonia begins with proper classification of disease based on age, distribution, and underlying etiology. The therapies available for dystonia include oral medications, botulinum toxin, and surgical procedures. Oral medications are generally reserved for generalized and segmental dystonia. Botulinum toxin revolutionized the treatment of focal dystonia when it was introduced for therapeutic purposes in the 1980s. Surgical procedures are available for medication-refractory dystonia, markedly affecting an individual's quality of life.
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Affiliation(s)
- Mary Ann Thenganatt
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030 USA
| | - Joseph Jankovic
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030 USA
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Abstract
The few controlled studies that have been carried out have shown that bilateral internal globus pallidum stimulation is a safe and long-term effective treatment for hyperkinetic disorders. However, most recent published data on deep brain stimulation (DBS) for dystonia, applied to different targets and patients, are still mainly from uncontrolled case reports (especially for secondary dystonia). This precludes clear determination of the efficacy of this procedure and the choice of the 'good' target for the 'good' patient. We performed a literature analysis on DBS for dystonia according to the expected outcome. We separated those with good evidence of favourable outcome from those with less predictable outcome. In the former group, we review the main results for primary dystonia (generalised/focal) and highlight recent data on myoclonus-dystonia and tardive dystonia (as they share, with primary dystonia, a marked beneficial effect from pallidal stimulation with good risk/benefit ratio). In the latter group, poor or variable results have been obtained for secondary dystonia (with a focus on heredodegenerative and metabolic disorders). From this overview, the main results and limits for each subgroup of patients that may help in the selection of dystonic patients who will benefit from DBS are discussed.
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Affiliation(s)
- Marie Vidailhet
- AP-HP, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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Vidailhet M, Jutras MF, Roze E, Grabli D. Deep brain stimulation for dystonia. HANDBOOK OF CLINICAL NEUROLOGY 2013; 116:167-187. [PMID: 24112893 DOI: 10.1016/b978-0-444-53497-2.00014-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The few reported controlled studies show that bilateral stimulation of the globus pallidus interna (GPi) is a safe and effective long-term treatment for hyperkinetic disorders. However, the recently published data on deep brain stimulation (DBS) applied to different targets or patients (especially those with secondary dystonia) are mainly uncontrolled case reports, precluding a clear determination of its efficacy, and providing little guidance as to the choice of a "good" target in a "good" patient. This chapter reviews the literature on DBS in primary dystonia, paying particular attention to the risk:benefit ratio in focal and segmental dystonias (cervical dystonia, cranial dystonia) and to the predictive factors for a good outcome. The chapter also highlights recent data on the marked benefits of the technique in myoclonus dystonia (in which pallidal, as opposed to thalamic, stimulation is more effective) and in tardive dystonia-dyskinesia. Although, the decision to treat appears relatively straightforward in patients with primary dystonia, myoclonus-dystonia, and tardive dystonia who have a normal findings on magnetic resonance imaging and normal cognitive function, there are still no reliable tools to help predict the timescale of postoperative benefit. This chapter provides a comprehensive analysis of the use of the treatment in various types of secondary dystonia, with little to moderate benefit in most cases, based on single cases or small series. Beyond the reduction in the severity of dystonia, the global motor and functional outcome is difficult to determine owing to the paucity of adequate evaluation tools. Because of the large interpatient variability, different targets may be effective depending on the symptoms in each individual.
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Affiliation(s)
- Marie Vidailhet
- Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Research Center of the Brain and Spinal Cord Institute, Université Paris 6/Inserm UMR S975, Paris, France; Pierre et Marie Curie Paris-6 University, Paris, France
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