Patterns of reoccurrence of segmental dystonia after discontinuation of deep brain stimulation

Grips, Eva; Blahak, Christian; Capelle, Hans‐Holger; Bäzner, Hansjörg; Weigel, Ralf; Sedlaczek, Oliver; Krauss, Joachim K.; Wöhrle, Johannes C.

doi:10.1136/jnnp.2006.089409

Cited by 58 publications

(54 citation statements)

References 16 publications

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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: 70%

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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Section: Discussionsupporting

confidence: 70%

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

et al. 2009

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“…Phasic elements of dystonia reappeared very quickly within less than 1 h, presumably caused by recurring oscillatory basal ganglia activity. In contrast, tonic elements of dystonia emerged progressively over 4 h of DBS discontinuation, most likely reflecting a gradual synaptic reorganization of basal ganglia circuits in terms of neuroplasticity [14,15] . The significant changes in electrode impedance after a period of DBS inactivity which have been described recently are of additional interest [16] , since even a moderate alteration in electrode impedance leads to significant changes in the volume of tissue activated by DBS [17] and thus altered clinical stimulation effects.…”

Section: Discussionmentioning

confidence: 99%

“…When turning GPi DBS off after several months of continuous stimulation, a progressive but more rapid increase in dystonic symptoms has been demonstrated [15] . Phasic elements of dystonia reappeared very quickly within less than 1 h, presumably caused by recurring oscillatory basal ganglia activity.…”

Section: Discussionmentioning

confidence: 99%

Less Is More: Adaptation of Voltage after Battery Replacement in Deep Brain Stimulation for Dystonia

Blahak

Capelle

Bäzner

et al. 2010

Stereotact Funct Neurosurg

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Background: To maintain the efficacy of deep brain stimulation (DBS) on dystonic symptoms, slight incremental increase in voltage may be necessary over years after a steady state has been reached following the initial programming of optimal settings. So far however, no data are available regarding the adjustment of voltage after implantable pulse generator (IPG) replacement to achieve sustained optimal control of dystonia with the least side effects. Methods: We analyzed stimulation settings before and after IPG replacement for battery depletion (n = 61) in 18 patients with chronic DBS of the globus pallidus internus or the ventral intermediate nucleus of the thalamus for dystonia. Results: The stimulation intensity could be significantly reduced by 24.8% after IPG replacement. The amount of voltage reduction was equal between bipolar and monopolar stimulation modes (24.9 vs. 24.3%, p = 0.89) and significantly correlated with the magnitude of stimulation intensity before IPG replacement (ρ = 0.429, p = 0.001). Conclusions: After IPG replacement, in patients with DBS for segmental dystonia the voltage can be reduced by approximately 25%. This phenomenon might be explained by a gradual decrease in the electrical energy effectively delivered by the IPG in the course of the lifetime of the battery or neuroplastic processes in particular in the period around battery replacement.

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“…1 have previously been published as a case report [8] . The effects on quality of life, as assessed by the SF-36, and the differential patterns of recurrence of dystonia after withdrawal of electrical stimulation for a subset of patients have also been reported elsewhere [11,12] . Postoperative short-term follow-up was obtained at a mean of 7 8 1.7 months (FU1, range 4-10 months) and long-term follow-up at a mean of 16.4 8 3.1 months (FU2, range 11-21 months).…”

Section: Methodsmentioning

confidence: 99%

Chronic Deep Brain Stimulation for Segmental Dystonia

Woehrle

Blahak²,

Kekelia³

et al. 2009

Stereotact Funct Neurosurg

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Fourteen consecutive patients with segmental dystonia underwent chronic deep brain stimulation (DBS) surgery in the frame of a prospective study protocol. Twelve patients received chronic pallidal stimulation, while 2 patients with prominent dystonic tremor received chronic thalamic ventrointermediate nucleus stimulation. Twelve patients had primary dystonia, and 2 patients secondary dystonia. The Burke-Fahn-Marsden dystonia rating scale (BFM motor) showed a mean relative improvement of 57.3% at the first follow-up (FU1, mean 7 months) and 57.8% at the second follow-up (FU2, mean 16 months). The mean BFM scores were 34.9 ± 17.7 preoperatively, 14.9 ± 11.7 at FU1, and 14.8 ± 10.3 at FU2. Scores of the disability subscale improved by 43% at FU1 and 36% at FU2. Improvement was comparatively less in those patients with secondary dystonia. Dysarthria was a limitation of DBS in 4 patients when using high voltage. Overall, chronic DBS is a very effective treatment option for medically refractory segmental dystonia.

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Patterns of reoccurrence of segmental dystonia after discontinuation of deep brain stimulation

Cited by 58 publications

References 16 publications

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

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

Less Is More: Adaptation of Voltage after Battery Replacement in Deep Brain Stimulation for Dystonia

Chronic Deep Brain Stimulation for Segmental Dystonia

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