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Ramirez-Zamora A, Eisinger RS, Haider SA, Youn Y, Shin D, Molho ES, Pilitsis JG. Pallidal deep brain stimulation and intraoperative neurophysiology for treatment of poststroke hemiballism. Ann Clin Transl Neurol 2018; 5:865-869. [PMID: 30009204 PMCID: PMC6043765 DOI: 10.1002/acn3.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 12/29/2022] Open
Abstract
Deep brain stimulation is a recognized and effective treatment for several movement disorders. Nevertheless, the efficacy of this intervention on abnormal movements secondary to structural brain pathologies is less consistent. In this report, we describe a case of hemiballism-hemichorea due to a peripartum ischemic stroke-treated with deep brain stimulation of the globus pallidus internus. Patient observed marked improvement in her symptoms at long-term follow-up. Neurophysiologic data revealed lower globus pallidus internus firing rates compared to other hyperkinetic disorders. Pallidal deep brain stimulation is a plausible option for medically refractory hemiballism-hemichorea and cumulative data from multiple centers may be used to fully evaluate its efficacy.
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Affiliation(s)
- Adolfo Ramirez-Zamora
- Department of Neurology Center for Movement Disorders and Neurorestoration Fixel Center for neurological disorders at the University of Florida Gainesville Florida
| | - Robert S Eisinger
- Department of Neurology Center for Movement Disorders and Neurorestoration Fixel Center for neurological disorders at the University of Florida Gainesville Florida
| | - Sameah A Haider
- Department of Neurosurgery Henry Ford Hospital Detroit Michigan
| | - Youngwon Youn
- Department of Neurosurgery Albany Medical Center Albany New York
| | - Damian Shin
- Department of Neuroscience and Experimental Therapeutics Albany Medical College Albany New York
| | - Eric S Molho
- Department of Neurology Albany Medical Center Albany New York
| | - Julie G Pilitsis
- Department of Neurosurgery Albany Medical Center Albany New York.,Department of Neuroscience and Experimental Therapeutics Albany Medical College Albany New York
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3
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Kannepalli NRVL, Yadav R, Vazhayil V, Somanna S, Pal PK. Ipsilateral Hemichorea-hemiballism in a Case of Postoperative Stroke. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:359. [PMID: 27127720 PMCID: PMC4825330 DOI: 10.7916/d8c53kqr] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/20/2016] [Indexed: 12/20/2022]
Abstract
Background Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on the same side of a brain lesion. Case report We describe a rare case of postoperative ipsilateral hemiballism in a patient who underwent pituitary adenoma resection and experienced a right internal cerebral artery territory infarct. We review the literature on hemichorea hemiballismus (HCHB) and explore various mechanisms for its occurrence. Discussion Only three cases of ipsilateral hemiballism have been described, and the exact pathophysiology remains unknown. A dominant left hemisphere with corpus callosal connections to the right basal ganglia is the most probable explanation for this unusual event.
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Affiliation(s)
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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4
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Abstract
Purpose of review Chorea can be due to a wide variety of causes. In this review, I provide updates on several recently identified genetic and autoimmune causes of chorea, and review evidence supporting the use of deep brain stimulation in chorea. Recent findings New genes that may cause chorea include ADCY5 (encoding for adenylate cyclase 5) C9ORF72 (in addition to amyotrophic lateral sclerosis and frontotemporal dementia), and those responsible for the neurodegeneration with brain iron accumulation disorders. Novel autoantibodies are increasingly being identified as associated with a variety of neurologic syndromes, including chorea, in both paraneoplastic and non-paraneoplastic settings. Deep brain stimulation can be a useful intervention in patients with chorea who do not respond to oral medications, whether due to neurodegenerative or nondegenerative causes. Summary New causes of chorea continue to be identified. Correct diagnosis is essential for prognostication and treatment.
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Affiliation(s)
- Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx; and Department of Neurology, Mount Sinai School of Medicine, New York, NY
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5
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Morigaki R, Mure H, Kaji R, Nagahiro S, Goto S. Therapeutic Perspective on Tardive Syndrome with Special Reference to Deep Brain Stimulation. Front Psychiatry 2016; 7:207. [PMID: 28082923 PMCID: PMC5183634 DOI: 10.3389/fpsyt.2016.00207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/15/2016] [Indexed: 12/28/2022] Open
Abstract
Tardive syndrome (TDS) is a potentially permanent and irreversible hyperkinetic movement disorder caused by exposure to dopamine receptor blocking agents. Guidelines published by the American Academy of Neurology recommend pharmacological first-line treatment for TDS with clonazepam (level B), ginkgo biloba (level B), amantadine (level C), and tetrabenazine (level C). Recently, a class II study provided level C evidence for use of deep brain stimulation (DBS) of the globus pallidus internus (GPi) in patients with TDS. Although the precise pathogenesis of TDS remains to be elucidated, the beneficial effects of GPi-DBS in patients with TDS suggest that the disease may be a basal ganglia disorder. In addition to recent advances in understanding the pathophysiology of TDS, this article introduces the current use of DBS in the treatment of medically intractable TDS.
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Affiliation(s)
- Ryoma Morigaki
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurodegenerative Disorders Research, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hideo Mure
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryuji Kaji
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Clinical Neuroscience, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shinji Nagahiro
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Satoshi Goto
- Parkinson's Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima University, Tokushima, Japan; Department of Neurodegenerative Disorders Research, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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6
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Sikri V, Jain A, Singhal V, Gupta A. A rare case of movement disorder in Intensive Care Unit. Indian J Crit Care Med 2016; 20:605-607. [PMID: 27829718 PMCID: PMC5073777 DOI: 10.4103/0972-5229.192055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hemichorea-hemiballismus syndrome (HCHB represents a peculiar form of hyperkinetic movement disorder with varying degrees of chorea and/or ballistic movements on one side of body. The patients are conscious of their environment but unable to control the movements. HCHB is a rare occurrence in acute stroke patients. Patients with sub-cortical strokes are more prone to develop movement disorders than with cortical stroke. We report one such interesting case here posing difficulties in management and intensive care of the patient. The patient remained refractory to all the drugs described in literature, and adequate control of the hyperkinetic movements could be achieved only with continuous intravenous sedation.
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Affiliation(s)
- Vikas Sikri
- Department of Critical Care, Fortis Hospital, Ludhiana, Punjab, India
| | - Alok Jain
- Department of Neurology, Fortis Hospital, Ludhiana, Punjab, India
| | - Vinay Singhal
- Department of Critical Care, Fortis Hospital, Ludhiana, Punjab, India
| | - Amit Gupta
- Department of Critical Care, Fortis Hospital, Ludhiana, Punjab, India
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7
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Delorme C, Rogers A, Lau B, Francisque H, Welter ML, Vidal SF, Yelnik J, Durr A, Grabli D, Karachi C. Deep brain stimulation of the internal pallidum in Huntington's disease patients: clinical outcome and neuronal firing patterns. J Neurol 2015; 263:290-298. [PMID: 26568561 DOI: 10.1007/s00415-015-7968-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/30/2015] [Accepted: 11/01/2015] [Indexed: 12/31/2022]
Abstract
Deep brain stimulation (DBS) of the internal globus pallidus (GPi) could treat chorea in Huntington's disease patients. The objectives of this study were to evaluate the efficacy of GPi-DBS to reduce abnormal movements of three patients with Huntington's disease and assess tolerability. Three non-demented patients with severe pharmacoresistant chorea underwent bilateral GPi-DBS and were followed for 30, 24, and 12 months, respectively. Primary outcome measure was the change of the chorea and total motor scores of the Unified Huntington's Disease Rating Scale between pre- and last postoperative assessments. Secondary outcome measures were motor changes between ventral versus dorsal and between on- and off- GPi-DBS. GPi neuronal activities were analyzed and compared to those obtained in patients with Parkinson's disease. No adverse effects occurred. Chorea decreased in all patients (13, 67 and 29%) postoperatively. Total motor score decreased in patient 2 (19.6%) and moderately increased in patients 1 and 3 (17.5 and 1.7%), due to increased bradykinesia and dysarthria. Ventral was superior to dorsal GPi-DBS to control chorea. Total motor score increased dramatically off-stimulation compared to ventral GPi-DBS (70, 63 and 19%). Cognitive and psychic functions were overall unchanged. Lower mean rate and less frequent bursting activity were found in Huntington's disease compared to Parkinson's disease patients. Ventral GPi-DBS sustainably reduced chorea, but worsened bradykinesia and dysarthria. Based on these results and previous published reports, we propose to select non-demented HD patients with severe chorea, and a short disease evolution as the best candidates for GPi-DBS.
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Affiliation(s)
- Cécile Delorme
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Alister Rogers
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France. .,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France. .,Neurosurgery department, Groupe Hospitalier Pitié-Salpêtrière, Brain and Spine Institute, CHU Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France.
| | - Brian Lau
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Hélène Francisque
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Marie-Laure Welter
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Sara Fernandez Vidal
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France.,Centre de Neuroimagerie de Recherche, Institut du Cerveau et de la Moelle épinière, 75013, Paris, France
| | - Jérôme Yelnik
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Alexandra Durr
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - David Grabli
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France
| | - Carine Karachi
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, 75013, Paris, France.,Neurosurgery department, Groupe Hospitalier Pitié-Salpêtrière, Brain and Spine Institute, CHU Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France
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8
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Garcia-Rill E, Luster B, D’Onofrio S, Mahaffey S, Bisagno V, Urbano FJ. Pedunculopontine arousal system physiology - Deep brain stimulation (DBS). Sleep Sci 2015; 8:153-61. [PMID: 26779322 PMCID: PMC4688589 DOI: 10.1016/j.slsci.2015.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 12/19/2022] Open
Abstract
This review describes the wake/sleep symptoms present in Parkinson׳s disease, and the role of the pedunculopontine nucleus in these symptoms. The physiology of PPN cells is important not only because it is a major element of the reticular activating system, but also because it is a novel target for deep brain stimulation in the treatment of gait and postural deficits in Parkinson׳s disease. A greater understanding of the physiology of the target nuclei within the brainstem and basal ganglia, amassed over the past decades, has enabled increasingly better patient outcomes from deep brain stimulation for movement disorders.
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Key Words
- Basal forebrain
- Calcium channels
- DBS, deep brain stimulation
- EEG, electroencephalogram
- Gamma band activity
- LC, locus coeruleus
- Lateral hypothalamus
- Orexin
- PD, Parkinson׳s disease
- PGO, ponto-geniculo-occipital
- PPN, pedunculopontine nucleus
- RAS, reticular activating system
- REM, rapid eye movement
- SN, substantia nigra
- STN, subthalamic nucleus
- SubCD, subcoeruleus nucleus dorsalis
- Tuberomammillary
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Affiliation(s)
- Edgar Garcia-Rill
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brennon Luster
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stasia D’Onofrio
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Mahaffey
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Veronica Bisagno
- IFIBYNE-CONICET and ININFA-CONICET, University of Buenos Aires, Argentina
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9
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TEKRIWAL A, BALTUCH G. Deep Brain Stimulation: Expanding Applications. Neurol Med Chir (Tokyo) 2015; 55:861-77. [PMID: 26466888 PMCID: PMC4686449 DOI: 10.2176/nmc.ra.2015-0172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/15/2015] [Indexed: 12/13/2022] Open
Abstract
For over two decades, deep brain stimulation (DBS) has shown significant efficacy in treatment for refractory cases of dyskinesia, specifically in cases of Parkinson's disease and dystonia. DBS offers potential alleviation from symptoms through a well-tolerated procedure that allows personalized modulation of targeted neuroanatomical regions and related circuitries. For clinicians contending with how to provide patients with meaningful alleviation from often debilitating intractable disorders, DBSs titratability and reversibility make it an attractive treatment option for indications ranging from traumatic brain injury to progressive epileptic supra-synchrony. The expansion of our collective knowledge of pathologic brain circuitries, as well as advances in imaging capabilities, electrophysiology techniques, and material sciences have contributed to the expanding application of DBS. This review will examine the potential efficacy of DBS for neurologic and psychiatric disorders currently under clinical investigation and will summarize findings from recent animal models.
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Affiliation(s)
- Anand TEKRIWAL
- University of Pennsylvania, Department of Neurosurgery, Philadelphia, USA
- University of Colorado School of Medicine and Graduate School of Neuroscience, MSTP, Colorado, USA (current affiliation)
| | - Gordon BALTUCH
- University of Pennsylvania, Department of Neurosurgery, Philadelphia, USA
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