Long-term efficacy with deep brain stimulation of the globus pallidus internus in cervical dystonia: a retrospective monocentric study

Jacksch, C.; Zeuner, Kirsten E.; Helmers, Ann‐Kristin; Witt, Karsten; Deuschl, G.; Paschen, Steffen

doi:10.1186/s42466-022-00214-8

Cited by 7 publications

(4 citation statements)

References 27 publications

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“…(1) Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has proven to be an effective therapeutic option for the treatment of medically refractory cervical dystonia. (2,3) Whilst the accuracy of GPi targeting in dystonia is the best predictor for a favourable outcome from DBS, in some cases, sufficient motor symptom improvements may still not be achieved. (4)(5)(6) The partial predictive ability of implantation accuracy and the poor understanding of disorder aetiology warrants the need for additional explanatory biomarkers for cervical dystonia.…”

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

Andrews

Keller

Osman-Farah

et al. 2023

Preprint

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Background: Cervical dystonia is a movement disorder, characterised by involuntary head and neck muscle contractions. Although deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment option, motor outcomes can vary even when sufficient targeting accuracy is achieved. Increasing evidence supports a role of brainstem and cerebellum dysfunction in cervical dystonia pathogenesis. Objective: To determine whether morphometry of brainstem and dentate nuclei, and DBS stimulatory overlap with cerebello-thalamic tracts modelled from normative connectivity, were related to DBS clinical motor outcomes. Methods: 27 patients with idiopathic cervical dystonia underwent bilateral targeting of the GPi. and were separated into suboptimal and optimal motor outcome groups. Dentate nuclei and brainstem volumes were quantified in association with clinical outcomes. A brainstem shape analysis was conducted and used as a seed to assess connectivity from a normative structural connectome. Patient-specific electrodes were modelled to quantify stimulatory overlap with the GPi and proximity to cerebellothalamic tracts. Results: GPi implantation accuracy did not significantly differ between groups. Significantly reduced dentate nuclei and brainstem volumes were observed in patients with poorer clinical outcomes. Regional surface shape change of the brainstem was also observed in patients with poorer responses. Fibre tracking from this area intersected cerebellar, pallidal and cortical motor regions. Electrode field intersection with the non-decussating dentatorubrothalamic tract in the right, and in both hemispheres were also positively associated with clinical outcome. Conclusions: Variability in cerebellar and brainstem morphometry, and stimulation of non-decussating cerebello-thalamic pathways may contribute to the mediation of DBS motor outcomes.

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Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

Andrews

Keller

Osman-Farah

et al. 2023

Preprint

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“…При этом преимущественно выполнялись односторонние вмешательства, поскольку двусторонние деструкции нередко сопровождались осложнениями (20-70% случаев), такими как дизартрия, дисфагия, атаксия, симптомы паркинсонизма [12,14,24]. С конца ХХ в. процедура ГСМ стала ведущим методом нейрохирургического лечения ЦД [15,26,27]. Стимуляция правого и левого внутреннего сегментов бледного шара (GPi-ГСМ) является самым распространённым методом лечения у пациентов с ЦД, которые не ответили на лекарственную и ботулиническую терапию.…”

Section: материалы и методыunclassified

“…3).ОбсуждениеЛечение пациентов с ЦД -большая проблема для неврологов[4,5,16,18]. Применение ГСМ является лучшим вариантом и позволяет значительно уменьшить симптомы ЦД[15,26], но в силу сложности методики и её малодоступности не все пациенты могут получить такой вид высокоспециализированной помощи. Альтернативным подходом функциональной нейрохирургии у этих пациентов может Для оценки уровня депрессии и тревоги у всех пациентов дополнительно проводили анкетирование по Госпитальной шкале тревоги и депрессии, шкале Монтгомери-Асберг[11].…”

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MRI-Guided Focused Ultrasound in Cervical Dystonia

Galimova,

Illarioshkin,

Buzaev

et al. 2024

Annals of Clinical and Experimental Neurology

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Introduction. MRI-guided focused ultrasound (MRgFUS) is approved for management of various movement disorders, primarily essential tremor and Parkinson’s disease (PD), with favorable long-term outcomes in numerous patients worldwide. However, few case studies describe the use of this modality for symptomatic treatment of dystonias that, as the third most common movement disorder, may be rather disabling. Objective: To improve outcomes in patients with cervical dystonia (CD) using MRgFUS. Materials and methods. We retrospectively analyzed 13 cases of various CD types managed with MRgFUS in single or multiple sessions. The mean age of the patients was 42 [39; 53] years. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was used to assess patients' statuses and severity of CD symptoms during therapy and the last available observation period. The targets included the pallidothalamic tract and the thalamic ventral oralis complex nucleus or their combination. Results. The mean follow-up period was 13.3 ± 3.4 months (July 2021 to April 2023). The mean CD severity sum score (TWSTRS score) was 22 [16; 25] before MRgFUS and 6 [4; 9] in the last observation. Therefore, we report 70.6% [55.6; 76.5] improvement (paired samples t-test p = 0.0025). Conclusion. Available data evidence that MRgFUS is efficient and sufficiently safe for symptomatic treatment in pharmacoresistant CD patients. A number of vital aspects of MRgFUS have to be specified in larger CD cohorts in the long-term follow-up.

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“…First line treatment is the repeated injection of botulinum neurotoxin (BoNT) [7]. Also, deep brain stimulation (DBS) of the globus pallidus internus (GPI) is a sustained effective therapeutic option for more severe cases [8,9]. Pharmacological treatment with various oral drugs (predominantly anticholinergics such as trihexyphenidyl) is of limited efficacy [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of Physiotherapy in the Treatment of Pain in Cervical Dystonia

Jacksch,

Loens,

Mueller

et al. 2024

TOHM

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Background: Cervical dystonia (CD) is the most common form of focal dystonia in adults. Studies show that physiotherapy (PT) in combination with BoNT has an effect on pain in cervical dystonia. We intended to test this hypothesis in a real-world setting to answer the question of whether pain is a good target symptom for prescribing PT. We also aimed to assess which form of PT is most appropriate for the treatment of pain. Methods: Study design: cross-sectional survey-based study of 91 patients with a confirmed diagnosis of cervical dystonia. The survey consisted of a questionnaire on type, frequency and content of physiotherapy, an assessment of quality of life with the Craniocervical Dystonia Questionnaire 24 (CDQ 24) and subjective pain scores. Results: 53.8% of patients received physiotherapy, mostly a mixture of exercises to either correct the abnormal posture or to reduce the muscle tone. Additional therapies included stress-reducing exercises (14.3%), psychotherapy (9.9%) and EMG biofeedback (2.2%). Patients who received PT showed a non-significant tendency towards higher pain scores. The severity of dystonia-associated pain was significantly associated with the patients’ quality of life (F (1,54) = 22.9, adjusted R2 = 0.286, p < 0.001). Discussion: Pain is a frequent problem in patients with CD and severely affects quality of life. Physiotherapy could therefore be a valuable treatment option for patients with CD and pain. Highlights Our uncontrolled study illustrates the high frequency of physiotherapy in addition to BoNT treatment in a real-life cohort of patients with cervical dystonia. We were able to show that PT reduces patients’ perceived pain in a patient reported outcome measure. This highlights the importance of PT in reducing CD-related pain, which considerably impairs quality of life.

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Long-term efficacy with deep brain stimulation of the globus pallidus internus in cervical dystonia: a retrospective monocentric study

Cited by 7 publications

References 27 publications

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

MRI-Guided Focused Ultrasound in Cervical Dystonia

Impact of Physiotherapy in the Treatment of Pain in Cervical Dystonia

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