gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Multifocal deep brain stimulation in patients with dystonia: A new treatment paradigm

Multifokale tiefe Hirnstimulation bei Patienten mit Dystonie: ein neuer Behandlungsansatz

Meeting Abstract

  • corresponding author Joachim K. Krauss - Departments of Neurosurgery and Neurology, University Hospital Mannheim, Mannheim
  • H. H. Capelle - Departments of Neurosurgery and Neurology, University Hospital Mannheim, Mannheim
  • C. Blahak - Departments of Neurosurgery and Neurology, University Hospital Mannheim, Mannheim
  • H. Bäzner - Departments of Neurosurgery and Neurology, University Hospital Mannheim, Mannheim
  • R. Weigel - Departments of Neurosurgery and Neurology, University Hospital Mannheim, Mannheim
  • J. C. Wöhrle - Departments of Neurosurgery and Neurology, University Hospital Mannheim, Mannheim

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.06.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0202.shtml

Veröffentlicht: 23. April 2004

© 2004 Krauss et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

There has been a renaissance of functional stereotactic surgery for treatment of dystonia. Chronic deep brain stimulation (DBS) of the posteroventral lateral globus pallidus internus (GPi) has been shown to provide substantial benefit in patients with idiopathic generalized dystonia. In the rare case, patients with unusual manifestations of dystonia have also been reported to benefit from thalamic ventrolateralis posterior (VLp) DBS. The purpose of this study was to evaluate which target is suited better in patients with dystonic tremor and secondary dystonia.

Methods

Six patients with medically refractory dystonia were selected for this prospective study. There were four women and two men. Three patients had secondary dystonia including peripherally-induced posttraumatic hemidystonia, head tremor secondary to head injury, and upper limb tremor associated with choreoathetosis due to cerebral palsy. The other patients had primary dystonia with prominent tremor involving the head (1), the neck and upper extremities (1), and the trunk when standing (1). All patients underwent bifocal implantation of quadripolar DBS electrodes in the GPi and the VLp, either bilaterally (5 patients) or unilaterally (1 patient) in the same operative session. Electrodes were externalized for test stimulation for several days.

Results

There were no adverse events. In four patients, it was possible to determine the more effective stimulation site during test stimulation. Rating scores showed that better improvement was achieved with pallidal stimulation in the three patients with primary dystonia, and that the posttraumatic dystonic head tremor was improved more markedly with VLp stimulation. No improvement of dystonia was observed in the two other patients with secondary dystonia during test stimulation, and these two patients underwent chronic alternating stimulation of the GPi and the VLp after implantation of pacemakers.

Conclusions

Multifocal DBS is a useful tool in patients with unusual manifestations of dystonia and those with secondary dystonia. It has been proven to be safe and effective in this series of patients.