Sustained quality‐of‐life improvements over 10 years after deep brain stimulation for dystonia

Hogg, Elliot; During, Emmanuel; Tan, Echo; Athreya, Kishore; Eskenazi, Jonathan; Wertheimer, Jeffrey; Mamelak, Adam N.; Alterman, Ron L.; Tagliati, Michele

doi:10.1002/mds.27426

Cited by 14 publications

(12 citation statements)

References 40 publications

(89 reference statements)

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“…Manifestations of parkinsonism, including bradykinesia and freezing of gait, have been described after chronic pallidal stimulation for dystonia [112][113][114] and may resolve upon using more dorsal contacts [113]. They increase in frequency with age, particularly after the fourth decade [98] and are therefore quite rare in the pediatric population. However, one study in DYT28 pediatric patients treated with GPi DBS reported freezing of gait at 3-6 years post-DBS [84].…”

Section: Adverse Effectsmentioning

confidence: 99%

Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia

Malatt

Tagliati²

2022

Pediatr Neurosurg

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Background Deep brain stimulation (DBS) has been utilized for over two decades to treat medication refractory dystonia in children. Short-term benefit has been demonstrated for inherited, isolated and idiopathic cases, with less efficacy in heredodegenerative and acquired dystonias. The ongoing publication of long-term outcomes warrants a critical assessment of available information as pediatric patients are expected to live most of their lives with these implants. Summary We performed a review of the literature for data describing motor and neuropsychiatric outcomes, in addition to complications, five or more years after DBS placement in patients undergoing DBS surgery for dystonia at an age younger than 21. We identified 20 articles including individual data on long-term motor outcomes after DBS for a total of 78 patients. In addition, we found five articles reporting long-term outcomes after DBS in nine patients with status dystonicus. The majority of patients were implanted within the globus pallidus internus, with only a few cases targeting the subthalamic nucleus and ventrolateral posterior nucleus of the thalamus. The average follow-up was 8.5 years, with a range up to 22 years. Long-term outcomes showed a sustained motor benefit, with median Burke-Fahn-Marsden dystonia rating score improvement ranging from 2.5% to 93.2% in different dystonia subtypes. Patients with inherited, isolated and idiopathic dystonias had greater improvement than those with heredodegenerative and acquired dystonias. Sustained improvements in quality of life were also reported, without the development of significant cognitive or psychiatric co-morbidities. Late adverse events tended to be hardware-related, with minimal stimulation-induced effects. Key Messages While data regarding long-term outcomes is somewhat limited, particularly with regards to neuropsychiatric outcomes and adverse events, improvement in motor outcomes appear to be preserved more than 5 years after DBS placement.

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Section: Adverse Effectsmentioning

confidence: 99%

Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia

Malatt

Tagliati²

2022

Pediatr Neurosurg

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“…We postulate that this could be due to stimulation effects of the contralateral GPi electrode, or direct lesioning effects of the GPi electrodes, or even the sequelae of the disease progression. Hypokinesia following bilateral pallidal DBS has been reported to more likely occur with high‐frequency stimulation and more ventral active contact . Stimulating another target, such as subthalamus, could be considered a possible alternative in this condition …”

Section: Serial Changes In the Severity Of Dystonia And Disability Ramentioning

confidence: 99%

“…Hypokinesia following bilateral pallidal DBS has been reported to more likely occur with high-frequency stimulation and more ventral active contact. 6 Stimulating another target, such as subthalamus, could be considered a possible alternative in this condition. 7 Finally, the subjective improvement in our patient's overall function was not reflected by the BFMDRS disability scale scores, possibly because the improvement in postural stability and pain were not adequately captured.…”

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confidence: 99%

Amelioration of Dystonic Opisthotonus in Pantothenate Kinase‐Associated Neurodegeneration Syndrome with Absent “Eye‐of‐the‐Tiger” Sign Following Bilateral Pallidal Deep Brain Stimulation

Fauzi

Ibrahim

Mukari

et al. 2019

Movement Disord Clin Pract

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“…A diagnosis of “primary dystonia” was often the main inclusion criterion, without further differentiation of the genetic background, while patients categorized as “secondary dystonia” were excluded in several studies. The same considerations apply to reports of long‐term follow‐up data on motor outcome and quality of life in DBS patients operated on more than five years ago . Resistance to the new terminology may arise from difficulty in translating this classic terminology to the new.…”

Section: Discussionmentioning

confidence: 99%

“…The recently published guideline for translating from old terminology may facilitate using the new classification for long‐term studies that were designed using the older definitions . There is a general belief that “primary” dystonia has a better post‐surgical outcome compared to “secondary” dystonia . This would be translated to say that idiopathic isolated dystonia has a more favorable outcome than acquired dystonia.…”

Section: Discussionmentioning

confidence: 99%

Implementation of the Current Dystonia Classification from 2013 to 2018

Sasikumar

Albanese

Krauss

et al. 2019

Movement Disord Clin Pract

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Background There is a discrepancy in the way dystonia is classified in the literature, as articles continue to reference the old criteria or fail to use the 2013 criteria correctly. Methods We performed a systematic review of the dystonia literature and distinguished between studies that use the new classification correctly, made errors in implementing the new classification, or continued to use the old classification methods. Results Of the 990 articles included in the study, 59.8% used the classification correctly, 31.3% used mixed terminology, and 8.9% continued to use the old classification. Articles relating to surgery were significantly less likely to use the new classification correctly. There is an upward trend in the annual rate of articles properly referencing the new classification. Conclusions The 2013 classification has been well received in scientific literature, and more studies are adapting to its use.

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Sustained quality‐of‐life improvements over 10 years after deep brain stimulation for dystonia

Abstract: DBS for dystonia results in long-term quality-of-life improvements that persist on average 10 years or more after surgery. The prevalence of stimulation-induced parkinsonism and cognitive impairment is low. © 2018 International Parkinson and Movement Disorder Society.

Cited by 14 publications

References 40 publications

Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia

Long-Term Outcomes of Deep Brain Stimulation for Pediatric Dystonia

Amelioration of Dystonic Opisthotonus in Pantothenate Kinase‐Associated Neurodegeneration Syndrome with Absent “Eye‐of‐the‐Tiger” Sign Following Bilateral Pallidal Deep Brain Stimulation

Implementation of the Current Dystonia Classification from 2013 to 2018

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