Artikel
Successful treatment of hemidystonia due to striatal lesions by unilateral stereotactic GPI – DBS: a report of 2 cases
Erfolgreiche Behandlung von 2 Patienten mit Hemidystonie durch striatale Läsionen mittels unilateraler GPI-Stimulation
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
To desribe the cases of 2 patients suffering from severe hemidystonic symptoms due to striatal lesions and their succesful treatment using bilateral GPI – DBS.
Background:Hemidystonia, due to different pathologies may be refractory to medical treatment. Despite an increasing number of publications descrinbing the results of DBS in generalized (mainly genetically determined) dystonia, there are only a few papers reporting onthe results of DBS in hemidystoniaas well as its anatomico – pathophysiological causes.
Methods
We describe the cases of a 64-year-old female and of a 58-year-old male suffering from severe hemidystonic symptoms for 8 years (female) and 6 months (male), respectively. We analysed the radiologicusing a unilateral stereotactic, microelectrode – guided GPI – DBS procedure using CT – MRI matching under local anesthesia. The microrecordings are analysed and referred to the stereotactic MRI/CT database.
Results
Both patients showed signs of striatal fibre degeneration in the IBZM SPECT, as well as one patient (female) with an additional contralateral hemibradykinesia showed a unilateral reduction of nigral levodopa production. In both cases, we did not see a sufficient clinical benefit from medical treatment with levodopa, benzodiazepines, tiapride, tetarbenazine and trihexiphenidyl. Both patients had a clear clinical benefit from the operation, resulting in a 70 to 90% motor and disability score improvement in the BFMDS. This effect occurred within the first 2 weeks after the oepration and remained stable at a 3 month follow-up. We did not observe any significant neuropsychological, any other medical side effects through the GPI stimulation.
Conclusions
Unilateral GPI is effective in the treatment of hemidystonia. Pathophysiological considerations about these 2 cases are discussed.