Five-Year Follow-Up of 10 Patients Treated with Globus Pallidus Internus Deep Brain Stimulation for Segmental or Multisegmental Dystonia

Abstract

Introduction: Globus pallidus internus (GPi) deep brain stimulation (DBS) represents a validated, effective, and safe treatment for patients affected by generalized dystonia resistant to conservative treatment. Segmental and multisegmental dystonia have more recently been proposed as further indications for GPi DBS despite the lack of long-term homogenous follow-up. Here we present an original and detailed long-term follow-up (5 years) of a homogeneous population of 11 patients affected by segmental or multisegmental dystonia. Materials and Methods: Ten patients underwent bilateral GPi DBS electrode implantations under a Leksell stereotactic guide, with intraoperative neurophysiological monitoring. The follow-ups at 1, 3 and 5 years were collected using video-BFMDRS for motor and disability scores. The statistical analysis of the results is provided. Results: We reported a statistically significant improvement in motor and disability overall scores until 5 years after treatment. At the last follow-up, even the single motor subitems were statistically improved. Discussion: We observed a continuous and statistically significant improvement in all of the motor subitems and in the overall disability score until the 3-year follow-up. These results did not improve any further but they appeared steady at the last follow-up. We also report a significant improvement in the cranial-cervical subitems. Conclusions: GPi DBS should definitely be considered a safe and effective treatment also for segmental and multisegmental dystonia even in cases of relevant or prevalent cranial-cervical involvement.

Deep brain stimulation with a pre-existing cochlear implant: Surgical technique and outcome

“…While this approach is reasonable for indirect targeting, it does not provide the resolution needed for direct targeting often used in STN or GPi surgery. In a more recent report by Buell et al .,[19] the authors successfully implanted bilateral STN DBS leads using MRI targeting by decoupling the MRI study (obtained before frame placement) from the CT study and merging the studies. They did, however, report significant signal artifact in the GPi which limited targeting to the STN.…”

“…This is consistent with previous case reports. [18192224] Caution is warranted, however, if consideration is being given to a rechargeable DBS generator as there is no prior data on the interference between the charging unit and the cochlear implant.…”

“…Buell et al . [19] surgically replaced the cochlear magnet immediately after the preoperative MRI but before DBS surgery to allow the patient hearing function. Unfortunately, activation of the device resulted in significant electrical artifact during microelectrode recording.…”

“…[18] More recently, MRI-guided bilateral DBS implantation was described in a patient with bilateral cochlear implants, albeit with the targeting being limited to the subthalamic nucleus (STN) due to significant signal artifact. [19]…”

Clinical outcome of deep brain stimulation for dystonia: constant‐current or constant‐voltage stimulation? A non‐randomized study

“…Bilateral globus pallidus deep brain stimulation (GPi‐DBS) represents an effective and relatively safe therapy for different forms of medically refractory dystonia. The best post‐operative outcomes are reported for primary generalized, segmental or multi‐segmental dystonias whilst the benefits for secondary dystonia are still unclear .…”