Cerebral glucose metabolism in patients with spasmodic torticollis

Magyar‐Lehmann, Stefanie; Antonini, Angelo; Roelcke, Ulrich; Maguire, R. Paul; Missimer, John; Meyer, M.E.; Leenders, Klaus L.

doi:10.1002/mds.870120513

Cited by 75 publications

(33 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent PET investigations have shown higher glucose metabolism bilaterally in the lentiform nucleus in patients with CD without significant differences regarding the laterality, the specific pattern, or the severity of CD in individual cases. 45 Bilateral basal ganglia involvement in CD has also been suggested by a recent SPECT study. 46 Striatal D2 receptor binding was significantly reduced in patients with CD compared with normal controls.…”

Section: Discussionmentioning

confidence: 77%

Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy

Tj²,

Pohle

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

192

103

View full text Add to dashboard Cite

Objectives: Surgical treatment of complex cervical dystonia and of cervical dyskinesias associated with cervical myelopathy is challenging. In this prospective study, the long term effect of chronic pallidal stimulation in cervical dystonia and on combining the technique with spinal surgery in patients with severe cervical dyskinesias and secondary cervical myelopathy is described. Methods: Eight patients with a history of chronic dystonia who did not achieve adequate benefit from medical treatment or botulinum toxin injection participated in the study. Five patients had complex cervical dystonia with tonic postures and phasic movements. Three patients had rapidly progressive cervical myelopathy secondary to severe cervical dyskinesias and dystonia in the context of a generalised movement disorder. Quadripolar electrodes were implanted in the posteroventral lateral globus pallidus internus with stereotactic CT and microelectrode guidance. In the three patients with secondary cervical myelopathy, spinal surgery was performed within a few weeks and included multilevel laminectomies and a four level cervical corporectomy with spinal stabilisation. Results: Improvement of the movement disorder was noted early after pallidal surgery, but the full benefit could be appreciated only with a delay of several months during chronic stimulation. Three months after surgery, patients with cervical dystonia had improved by 38% in the severity score, by 54% in the disability score, and by 38% in the pain score of a modified version of the Toronto western spasmodic torticollis rating scale. At a mean follow up of 20 months, the severity score had improved by 63%, the disability score by 69%, and the pain score by 50% compared with preoperatively. There was also sustained amelioration of cervical dyskinesias in the three patients who underwent spinal surgery. Lead fractures occurred in two patients. The mean amplitude needed for chronic deep brain stimulation was 3.8 V at a mean pulse width of 210 µs, which is higher than that used for pallidal stimulation in Parkinson's disease. Conclusions: Chronic pallidal stimualtion is effective for complex cervical dystonia and it is a useful adjunct in patients with cervical dyskinesias and secondary cervical myelopathy who undergo spinal surgery.

show abstract

Section: Discussionmentioning

confidence: 77%

Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy

Tj²,

Pohle

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

192

103

View full text Add to dashboard Cite

show abstract

“…Furthermore, intraoperative physiological studies from several groups appeared to be at odds with Hassler's concepts [31]. Findings from modern functional neuroimaging studies indicate that there is bilateral striatal dysfunction regardless of the phenomenology of CD [68,69]. Dysfunction of other systems in addition to the basal ganglia circuitry has been considered to be relevant for the development of CD.…”

Section: Discussionmentioning

confidence: 93%

Functional Stereotactic Surgery for Treatment of Cervical Dystonia: Review of the Experience from the Lesional Era

Loher

Pohle

Krauss

2004

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

Background: Functional stereotactic neurosurgery has been rediscovered as a powerful tool to treat various manifestations of medically refractory dystonia. The purpose of this study was to provide the first systematic review of previous experience with thalamic and basal ganglia surgery in the treatment of cervical dystonia (CD). Methods: A comprehensive review of the literature published between 1950 and 1990 was performed. In addition, data from an unpublished doctoral thesis on 162 patients with CD operated on by Mundinger between 1972 and 1986 were analyzed. Results: Overall, there is published documentation of experience with more than 300 patients with CD who underwent functional stereotactic surgery between the late 1950s and the early 1980s. In general, amelioration of CD was achieved in about 50–70% of patients in most studies. Bilateral surgery generally provided better outcomes than unilateral surgery. Postoperative benefit was reported to become evident only after a delay in several studies. Some reports demonstrated sustained benefit after follow-up of more than 5 years. Bilateral procedures, in particular bilateral thalamotomies, were clearly associated with a higher rate of postoperative side effects, such as dysarthria, dysphagia and ataxia, ranging from 20 to 70%. In the first decade after its introduction, thalamotomy was the preferred procedure. Later, the subthalamic area was targeted more frequently in order to affect pallidal outflow. Experience with targeting the pallidum proper was limited. Functional stereotactic surgery for CD was abandoned in the late 1970s for several reasons, including the general decline in movement disorder surgery at that time, the introduction of selective peripheral denervation and the widespread and beneficial use of botulinum toxin soon thereafter. Conclusions: Functional stereotactic surgery for treatment of CD has a rich history. There are several lessons to be learned from review of earlier experience. Contemporary techniques have led to a significant improvement in the benefit to risk ratio, in particular regarding bilateral surgery.

show abstract

“…There is evidence that involvement is bilateral, regardless of the specific pattern of CD. PET investigations of patients with CD have shown increased bilateral glucose metabolism in the lentiform nucleus [40]. There were no significant differences concerning the laterality, the specific pattern, or the severity of CD in individual cases.…”

Section: Pallidal Dbs For Cervical Dystoniamentioning

confidence: 92%

Deep Brain Stimulation for Dystonia in Adults

Krauss

2002

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

The renaissance of functional neurosurgery in the treatment of Parkinson’s disease has sparked also the interest in other movement disorders which are refractory to medical treatment. Deep brain stimulation (DBS) has been used only since a few years in dystonia patients. This review summarizes the available data on pallidal and thalamic DBS for various dystonic syndromes. The major advantage of DBS as compared to radiofrequency lesioning is that it allows performing contemporaneous bilateral surgery with relatively low morbidity in these patients. The posteroventral lateral globus pallidus internus (GPi) has been the preferred target in most instances, thus far. While phasic dystonic movements may improve early after surgery, the response of tonic dystonic movements to chronic stimulation may be delayed. The most beneficial results have been achieved in patients with primary genetic generalized and segmental dystonia, myoclonic dystonia, and complex cervical dystonia. Outcome has been varied in patients with other dystonic disorders, in particular those with secondary dystonia. Most studies have reported on relatively short follow-up periods, on single cases, or were retrospective. Pallidal DBS has been shown to be effective in complex cervical dystonia yielding both symptomatic and functional benefit for up to 2.5 years of follow-up. Dramatic improvement has been obtained in children and in adults with DYT1 positive dystonia. Also, patients with non DYT1 genetic dystonia achieved sustained benefit for up to 2 years of follow-up. Preliminary experience indicates that choreoathetosis in patients with cerebral palsy responds less well to pallidal DBS, and that it may not be effective at all in some patients. In single instances unilateral pallidal DBS has been shown to yield valuable benefit in patients with hemidystonia. The experience with DBS for treatment of Meige syndrome and other focal dystonias has been explored only recently. There is much less experience with thalamic DBS for dystonia. Thalamic DBS has been shown to be effective in single cases with posttraumatic dystonia, postanoxic dystonia and paroxysmal nonkinesigenic dystonia. Future perspectives of DBS for treatment of dystonia include the development of new technology, the evaluation of the possible role of other targets, and carefully planned studies to further establish the role of surgery.

show abstract

Cerebral glucose metabolism in patients with spasmodic torticollis

Cited by 75 publications

References 26 publications

Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy

Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy

Functional Stereotactic Surgery for Treatment of Cervical Dystonia: Review of the Experience from the Lesional Era

Deep Brain Stimulation for Dystonia in Adults

Contact Info

Product

Resources

About