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Aggarwal A, Adukia S, Bhatt M. Video Anthology of Movement Disorders Due to Infections in South Asia. Mov Disord Clin Pract 2021; 8:843-858. [PMID: 34405094 DOI: 10.1002/mdc3.13275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/23/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
South Asia, encompassing many populous countries including India, Pakistan, and Bangladesh, is home to a wide variety of infectious diseases several of which are disproportionately prevalent, endemic or distinctive to the region. These result in considerable morbidity and mortality, which can be greatly reduced through public-health measures, timely diagnosis and treatment. Some of these infectious diseases have neurological manifestations including movement disorders either due to the pathogen being neuroinvasive or via an immune-mediated response. For diseases such as Japanese encephalitis, movement disorders are the primary manifestation while for others, they can be a presenting feature. Thus, recognizing these movement disorders is often crucial to the diagnosis of the particular infection, and/or to exclude infection as a cause and arrive at the correct alternate diagnosis. Once diagnosed, the infection-related movement disorders are treated by targeting the infectious agent, or symptomatically. In this article, we describe and illustrate a variety of movement disorders that are seen in patients infected by viruses, bacteria and parasites in South Asia. This would be of value to neurologists practicing in the region and, with the increasing ease in movement of people and pathogens, those practicing elsewhere.
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Affiliation(s)
- Annu Aggarwal
- Movement Disorder Clinic, Department of Neurosciences Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Mumbai India
| | - Sachin Adukia
- Movement Disorder Clinic, Department of Neurosciences Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Mumbai India
| | - Mohit Bhatt
- Movement Disorder Clinic, Department of Neurosciences Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Mumbai India
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Levi V, Zorzi G, Messina G, Romito L, Tramacere I, Dones I, Nardocci N, Franzini A. Deep brain stimulation versus pallidotomy for status dystonicus: a single-center case series. J Neurosurg 2021:1-11. [DOI: 10.3171/2019.10.jns191691] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/03/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEFirst-line pharmacological therapies have shown limited efficacy in status dystonicus (SD), while surgery is increasingly reported as remediable in refractory cases. In this context, there is no evidence regarding which neurosurgical approach is the safest and most effective. The aim of this study was to assess the clinical outcomes and surgery-related complications of globus pallidus internus deep brain stimulation (GPi DBS) and pallidotomy for the treatment of drug-resistant SD.METHODSThe authors reviewed the records of patients with drug-resistant SD who had undergone GPi DBS or pallidotomy at their institution between 2003 and 2017. The severity of the dystonia was evaluated using the Barry-Albright Dystonia (BAD) Scale. Surgical procedures were performed bilaterally in all cases.RESULTSFourteen patients were eligible for inclusion in the study. After surgery, the mean follow-up was 40.6 ± 30 months. DBS ended the dystonic storm in 87.5% of cases (7/8), while pallidotomy had a success rate of 83.3% (5/6). No significant differences were observed between the two techniques in terms of failure rates (risk difference DBS vs pallidotomy −0.03, 95% CI −0.36 to 0.30), SD mean resolution time (DBS 34.8 ± 19 days, pallidotomy 21.8 ± 20.2 days, p > 0.05), or BAD scores at each postoperative follow-up (p > 0.05). The long-term hardware complication rate after DBS was 37.5%, whereas no surgery-related complications were noted following pallidotomy.CONCLUSIONSThe study data suggest that DBS and pallidotomy are equally safe and effective therapies for drug-resistant SD. The choice between the two techniques should be tailored on a case-by-case basis, depending on factors such as the etiology and evolution pattern of the underlying dystonia and the clinical conditions at the moment of SD onset. Given the limitation of the low statistical power of this study, further multicentric investigations are needed to confirm its findings.
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Affiliation(s)
- Vincenzo Levi
- 1Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
- 2Department of Electronics, Information and Bioengineering, Polytechnic University of Milan
| | - Giovanna Zorzi
- 3Pediatric Neuroscience Department, Child Neuropsychiatry Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Giuseppe Messina
- 1Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Luigi Romito
- 4Neurology Department, Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta; and
| | - Irene Tramacere
- 5Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ivano Dones
- 1Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Nardo Nardocci
- 3Pediatric Neuroscience Department, Child Neuropsychiatry Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Angelo Franzini
- 1Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
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Centen LM, Oterdoom DLM, Tijssen MAJ, Lesman-Leegte I, van Egmond ME, van Dijk JMC. Bilateral Pallidotomy for Dystonia: A Systematic Review. Mov Disord 2020; 36:547-557. [PMID: 33215750 PMCID: PMC8048649 DOI: 10.1002/mds.28384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/27/2022] Open
Abstract
Stereotactic lesioning of the bilateral globus pallidus (GPi) was one of the first surgical treatments for medication‐refractory dystonia but has largely been abandoned in clinical practice after the introduction of deep brain stimulation (DBS). However, some patients with dystonia are not eligible for DBS. Therefore, we reviewed the efficacy, safety, and sustainability of bilateral pallidotomy by conducting a systematic review of individual patient data (IPD). Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and IPD were followed. In May 2020, Medline, Embase, Web of Science, and Cochrane Library were searched for studies reporting on outcome of bilateral pallidotomy for dystonia. If available, IPD were collected. In this systematic review, 100 patients from 33 articles were evaluated. Adverse events were reported in 20 patients (20%), of which 8 were permanent (8%). Pre‐and postoperative Burke‐Fahn‐Marsden Dystonia Rating Movement Scale scores were available for 53 patients. A clinically relevant improvement (>20%) of this score was found in 42 of 53 patients (79%). Twenty‐five patients with status dystonicus (SD) were described. In all but 2 the SD resolved after bilateral pallidotomy. Seven patients experienced a relapse of SD. Median‐reported follow‐up was 12 months (n = 83; range: 2–180 months). Based on the current literature, bilateral pallidotomy is an effective and relatively safe procedure for certain types of dystonia, particularly in medication‐refractory SD. Although due to publication bias the underreporting of negative outcomes is very likely, bilateral pallidotomy is a reasonable alternative to DBS in selected dystonia patients. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Liesanne M Centen
- Department of Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.,Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Ivon Lesman-Leegte
- Department of Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.,Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Martje E van Egmond
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.,Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Abstract
Background: Ablative therapies have been used for the treatment of neurological disorders for many years. They have been used both for creating therapeutic lesions within dysfunctional brain circuits and to destroy intracranial tumors and space-occupying masses. Despite the introduction of new effective drugs and neuromodulative techniques, which became more popular and subsequently caused brain ablation techniques to fall out favor, recent technological advances have led to the resurgence of lesioning with an improved safety profile. Currently, the four main ablative techniques that are used for ablative brain surgery are radiofrequency thermoablation, stereotactic radiosurgery, laser interstitial thermal therapy and magnetic resonance-guided focused ultrasound thermal ablation. Object: To review the physical principles underlying brain ablative therapies and to describe their use for neurological disorders. Methods: The literature regarding the neurosurgical applications of brain ablative therapies has been reviewed. Results: Ablative treatments have been used for several neurological disorders, including movement disorders, psychiatric disorders, chronic pain, drug-resistant epilepsy and brain tumors. Conclusions: There are several ongoing efforts to use novel ablative therapies directed towards the brain. The recent development of techniques that allow for precise targeting, accurate delivery of thermal doses and real-time visualization of induced tissue damage during the procedure have resulted in novel techniques for cerebral ablation such as magnetic resonance-guided focused ultrasound or laser interstitial thermal therapy. However, older techniques such as radiofrequency thermal ablation or stereotactic radiosurgery still have a pivotal role in the management of a variety of neurological disorders.
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Affiliation(s)
- Andrea Franzini
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA.,Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta , Milan , Italy
| | - Shayan Moosa
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA
| | - Domenico Servello
- Department of Neurosurgery, Galeazzi Research and Clinical Hospital , Milan , Italy
| | - Isabella Small
- Focused Ultrasound Foundation , Charlottesville , VA , USA
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta , Milan , Italy.,Department of Pathophysiology and Transplantation, University of Milan , Milan , Italy.,Department of Neurological Surgery, Johns Hopkins Medical School , Baltimore , MD , USA
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA
| | - William Jeffrey Elias
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA
| | - Angelo Franzini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta , Milan , Italy
| | - Francesco Prada
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA.,Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta , Milan , Italy.,Focused Ultrasound Foundation , Charlottesville , VA , USA
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