Article
Multifocal deep brain stimulation in patients with dystonia: A new treatment paradigm
Multifokale tiefe Hirnstimulation bei Patienten mit Dystonie: ein neuer Behandlungsansatz
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Published: | April 23, 2004 |
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Outline
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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.