Postanoxic generalized dystonia improved by bilateral Voa thalamic deep brain stimulation

Abstract

A patient with severe postanoxic dystonia and bilateral necrosis of the basal ganglia, who was confined to a wheelchair, underwent bilateral ventralis oralis anterior deep brain stimulation (Voa-DBS) after 6 weeks of unsuccessful bilateral pallidal DBS (GPi-DBS). After 4 months of high intensity Voa-DBS, cognitively unimpaired, he showed major improvement in dystonia, became ambulant, but committed suicide. Brain examination confirmed the correct location of the electrodes in GPi and Voa on both sides.

The Effect of Bilateral Globus Pallidus Internus Deep Brain Stimulation plus Ventralis Oralis Thalamotomy on Patients with Cerebral Palsy

“…In recent studies, the use of specified nuclei targets such as the ventralis oralis anterior (Voa), ventralis oralis posterior (Vop) and Vim has led to more effective results in dystonic patients [16,17,18]. Thalamotomy has been reported to be more effective for secondary dystonia than pallidotomy [12].…”

“…Moreover, the pallidal circuit of patients with CP due to perinatal brain injury is not comparable to that of normal people due to the possibility of multiregion involvement. Thus, new targets such as Voa, Vop and Vim are necessary [18]. According to Katsakiori et al [7], 1 patient with secondary dystonia underwent Voa DBS with an excellent functional outcome.…”

Dystonia and DBS: The Jury Arrives

“…There are reports of DBS in postanoxic dystonia, postencephalitic dystonia, and posttraumatic dystonia (Eltahawy et al, 2004;Pretto et al, 2008;Katsakiori et al, 2009;Zhang et al, 2006;Krause et al, 2004;Ghika et al, 2002). Improvements in dystonia in Lesch-Nyhan syndrome (Cif et al, 2007;Pralong et al, 2005) and GM1 gangliosidosis (Roze et al, 2006) also have been reported.…”

Deep Brain Stimulation for Movement Disorders

“…The STN may avoid stimulation-induced bradykinesia, but other issues, such as transient dyskinesia and possible weight gain in some patients, have been observed. Finally, there are a few published reports of DBS in the ventrooralis and Vim nucleus of the thalamus for writer's cramp and the ventrooralis anterior nucleus for a postanoxic dystonia [92,93]. Larger, prospective studies are needed to compare and contrast these targets in a scientifically meaningful way [94].…”