Long-term effects of pallidal deep brain stimulation in tardive dystonia

Gruber, Doreen; Trottenberg, Thomas; Kivi, Anatol; Schoenecker, Thomas; Kopp, Ute A.; Hoffmann, Karl‐Titus; Schneider, Gerd‐Helge; Kühn, Andrea A.; Kupsch, Andreas

doi:10.1212/wnl.0b013e3181aaea01

Cited by 155 publications

(154 citation statements)

References 28 publications

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“…The stimulation parameters are typically the same as for PD, although some patients may also respond to lower frequencies. There is growing evidence supporting the use of GPi DBS for the treatment of tardive dystonia or myoclonus dystonia [244][245][246][247][248][249][250][251][252][253][254]. Lesser and inconsistent benefit is seen in dystonia secondary to structural brain damage [255].…”

Section: Use Of Dbs For Dystoniamentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

2016

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Deep brain stimulation (DBS) is highly effective for both hypo-and hyperkinetic movement disorders of basal ganglia origin. The clinical use of DBS is, in part, empiric, based on the experience with prior surgical ablative therapies for these disorders, and, in part, driven by scientific discoveries made decades ago. In this review, we consider anatomical and functional concepts of the basal ganglia relevant to our understanding of DBS mechanisms, as well as our current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson's disease and dystonia. Finally, we discuss the proposed mechanism(s) of action of DBS in restoring function in patients with movement disorders. The signs and symptoms of the various disorders appear to result from signature disordered activity in the basal ganglia output, which disrupts the activity in thalamocortical and brainstem networks. The available evidence suggests that the effects of DBS are strongly dependent on targeting sensorimotor portions of specific nodes of the basal gangliathalamocortical motor circuit, that is, the subthalamic nucleus and the internal segment of the globus pallidus. There is little evidence to suggest that DBS in patients with movement disorders restores normal basal ganglia functions (e.g., their role in movement or reinforcement learning). Instead, it appears that high-frequency DBS replaces the abnormal basal ganglia output with a more tolerable pattern, which helps to restore the functionality of downstream networks.

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Section: Use Of Dbs For Dystoniamentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

2016

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“…13 In contrast, the success of pallidal DBS in the treatment of primary dystonias led to its adoption for secondary dystonias such as TD. [5][6][7]14,15 In this series we demonstrate a significant beneficial effect for medically refractory TD where rapid remarkable improvements in motor symptoms were observed within days without exacerbation of psychiatric symptoms. Our results are in agreement with other DBS outcome trials for TD.…”

Section: Discussionmentioning

confidence: 51%

“…4 The motor benefits are sustainable with a documented duration of 41 months (range, 18-80 months). 5,7,16 Long-term responses for 8 to 10 years have also been reported. 6,17 Although most data were from case studies or small trials, our experience supports DBS as an effective and safe surgical treatment modality that can considerably improve QoL.…”

Section: Discussionmentioning

confidence: 93%

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Pallidal deep brain stimulation: an effective treatment in Chinese patients with tardive dystonia

et al. 2014

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A B S T R A C TTardive dystonia is an iatrogenic complication of dopamine receptor antagonist medication such as first-generation antipsychotics. It occurs in up to 2% of patients and only 10% recover after stopping medication. Deep brain stimulation for primary dystonia has proven to be effective and its application for secondary dystonias is gaining acceptance. We report our experience in treating three ethnic Chinese schizophrenia patients with severe medically refractory tardive dystonia by globus pallidus internus deep brain stimulation. Preoperatively, all required assistance with essential activities of daily living and two were bed-bound. The mean Burke-Fahn-Marsden Dystonia Rating Scale score was 61 (range, 44-80) and mean Global Dystonia Rating Scale score was 47 (range, 40-52). No procedure-related complications were encountered. By 3 months all could return to unassisted living and walk with support with a mean of 77% and 66% improvement in the Burke-Fahn-Marsden Dystonia Rating Scale and Global Dystonia Rating Scale scores, respectively. Quality-of-life assessment performed for two patients using the EuroQol-5 dimensions visual analogue scale showed a mean improvement of 86% at 3 months. On clinical follow-up, the effect has proven to be effective for secondary dystonias such as TD. [4][5][6][7] We report our experience with using DBS for treating three young ethnic Chinese patients with severe TD refractory to pharmacological management. Case reports Clinical assessmentThree paranoid schizophrenia patients were referred by psychiatrists for TD satisfying the proposed diagnostic criteria by Adityanjee et al. 2 All three patients were managed by the

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“…While secondary dystonia is generally less responsive to DBS, one exception is tardive dystonia, for which there are Ona = onbotulinumtoxinA; Abo = abobotulinumtoxinA; Inco = incobotulinumtoxinA; Rima = rimabotulinumtoxinB; JRS = Jankovic Rating Scale; BDSI = Blepharospasm Disability Index; TWSTRS = Toronto Western Spasmodic Torticollis Rating Scale several reports of robust improvement with long-term benefit [62,63]. Case reports of other forms of secondary dystonia responsive to DBS include neurodegeneration with brain iron accumulation, dopa-responsive dystonia, X-linked dystonia parkinsonism, and post-infarct hemidystonia [64][65][66][67][68].…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Treatment of Dystonia

Thenganatt

Jankovic

2014

Neurotherapeutics

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Selecting the appropriate treatment for dystonia begins with proper classification of disease based on age, distribution, and underlying etiology. The therapies available for dystonia include oral medications, botulinum toxin, and surgical procedures. Oral medications are generally reserved for generalized and segmental dystonia. Botulinum toxin revolutionized the treatment of focal dystonia when it was introduced for therapeutic purposes in the 1980s. Surgical procedures are available for medication-refractory dystonia, markedly affecting an individual's quality of life.

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Long-term effects of pallidal deep brain stimulation in tardive dystonia

Abstract: Pallidal deep brain stimulation is a safe and effective long-term treatment in patients with medically refractory tardive dystonia.

Cited by 155 publications

References 28 publications

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

Pallidal deep brain stimulation: an effective treatment in Chinese patients with tardive dystonia

Treatment of Dystonia

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