Globus pallidus deep brain stimulation in dystonia

Diamond, Alan; Jimenez-Shahed, Joohi; Azher, Shaheda N.; Dat-Vuong, Kevin; Jankovic, Joseph

doi:10.1002/mds.20767

Cited by 74 publications

(34 citation statements)

References 15 publications

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“…Despite previous reports [11,13,16,23,24] , in our case series the clinical results were statistically significant also in facial movements and speech production even 5 years after surgery (speech/swallowing, 58% at 3 years and 55% at 5 years; table 2 ; fig. 4 , online supplementary video 1; for all online supplementary material, see www.…”

Section: Discussioncontrasting

confidence: 53%

“…Deep brain stimulation (DBS) has emerged in the last 10 years as an effective and reversible therapeutic option for patients with medically refractory dystonia [7][8][9][10][11][12] . The posteroventral globus pallidus internus (GPi) is the main target for treatment of primary dystonia as demonstrated by different authors [13][14][15][16] . However, only few case series have been reported in the literature analyzing long-term follow-ups of patients treated with GPi DBS for focal or segmental dystonia [17][18][19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

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

Sarubbo¹,

Latini²,

Quatrale

et al. 2012

Stereotact Funct Neurosurg

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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.

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Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

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

Sarubbo¹,

Latini²,

Quatrale

et al. 2012

Stereotact Funct Neurosurg

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“…Finally if one further segregated our data to only include DYT-1 primary generalized cases, the benefit jumped to 48%. Table 9 continued Author Type of study Type of dystonia Though the UDRS is less utilized, our study coupled with those from Grips [18], Diamond [14], Evidente [17] and Margarinos-Ascone [35] demonstrates that UDRS findings are comparable to BFMDRS-M score reports in accuracy and reliabililty. In our study, both the UDRS and BFMDRS-M measured the severity and duration of dystonia.…”

Section: Discussionsupporting

confidence: 72%

An evaluation of rating scales utilized for deep brain stimulation for dystonia

et al. 2009

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The objective of this study was to examine globus pallidus internus deep brain stimulation (GPi-DBS) outcomes in primary and secondary dystonia, derived from blinded ratings using two scales and two raters. Twenty-five patients with variable presentations of dystonia were evaluated with videotaped standardized dystonia rating scales at preoperative baseline and at 6 and 12 months following GPi-DBS implantation. These 75 examination videos were retrospectively evaluated, independently and in random order, by two movement disorder neurologists who were blinded to the treatment status. Both neurologists scored each videotaped evaluation using the Burke-Fahn-Marsden Dystonia Rating Scale-motor part (BFMDRS-M) and the Unified Dystonia Rating Scale (UDRS). A final score for each video was assigned by averaging the raters' scores. An intra-class correlation coefficient was used to calculate inter-rater reliability. A linear mixed model was fitted to investigate the time effect and its interaction with type of dystonia (primary versus secondary) for each rating scale. Inter-rater reliability was excellent. Intraclass correlation coefficients ranged from 0.994 to 0.997 for both scales at baseline, 6 and 12 months. The average motor improvement scores after GPi DBS for the entire heterogeneous group of dystonia patients after 6 and 12 months of stimulation was 21.32% (p = 0.0010) and 28.95% (p = 0.0017), respectively, when the UDRS score was used. Similar levels of improvement 20.46% (p = 0.0055) at 6 months and 27.39% (p = 0.00197) at 12 months were found using the BFMDRS-M score. Analysis using unblinded scores from our database revealed a 32.99 and 37.27% UDRS improvement at 6 and 12 months, and an improvement in UDRS score of 38.5 and 43.7% when the analysis was limited to only primary dystonia. If the data were further segregated to include only cases of DYT-1 primary generalized dystonia, the UDRS benefit increased to 48.24%. Our primary dystonia group was diluted by the presence of both old- and young-onset patients, as well as focal, segmental and generalized dystonia. In conclusion, (1) evaluating motor outcomes of DBS therapy for dystonia using independent, randomized retrospective rating by blinded raters' results in lower improvement scores than when outcomes are rated by unblinded treating neurologists. Blinded methodology may be superior and might produce a more realistic assessment of motor outcomes after DBS in patients with dystonia; (2) outcomes were similar whether the BFMDRS-M or UDRS was utilized; (3) GPi-DBS was effective in treating sustained involuntary motor co-contractions in medication refractory dystonia patients, more so in primary dystonia.

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“…After that, two multicenter studies on bilateral Globus Pallidus pars Interna (GPi) DBS have demonstrated convincing clinical benefit on a large number of patients with primary generalized/segmental dystonia [7][8][9]. Accordingly, GPi DBS was approved by FDA in 2003 (as a humanitarian device exemption) for patients with chronic, medically intractable dystonia [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

12 Deep Brain Stimulation for Dystonia

Bakay¹

2009

Movement Disorder Surgery

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Deep brain stimulation (DBS) is an effective surgical treatment for medication-refractory movement disorders, and has been approved by the United States Food and Drug Administration for treatment of dystonia. The success of DBS in the treatment of dystonia depends on our understanding of the anatomy and physiology of this disorder and close collaboration between neurosurgeons, neurologists, clinical neurophysiologists, neuroradiologists and neuropsychologists. Currently, pallidal DBS is an established treatment option for medically refractive dystonia. This review is intended to provide a comprehensive review of the use of DBS for dystonia, focusing mainly on the surgical aspects, clinical outcome, MRI findings and side effects of DBS.

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Globus pallidus deep brain stimulation in dystonia

Cited by 74 publications

References 15 publications

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

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

An evaluation of rating scales utilized for deep brain stimulation for dystonia

12 Deep Brain Stimulation for Dystonia

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