Article
A prospective, randomized assessment of pallidal, thalamic and multifocal deep brain stimulation in a case of stroke-induced hemidystonia
Search Medline for
Authors
-
Philipp J. Slotty
- Division of Neurosurgery, University of British Columbia, Vancouver, Canada; Abteilung für Stereotaxie und Funktionelle Neurochirurgie, Heinrich-Heine Universität, Düsseldorf, Deutschland
-
Christopher R. Honey
- Division of Neurosurgery, University of British Columbia, Vancouver, Canada
| Published: | June 2, 2015 |
|---|
Outline
Text
Objective: In primary and generalized dystonia, the internal pallidum (GPi) is the most common target for deep brain stimulation (DBS) and provides good to excellent results in the majority of patients. Our results in secondary dystonia due to stroke have not been as good and prompted a search for additional DBS targets. The thalamus (Vim/Vop) has been lesioned with success in dystonia and we therefore undertook a study to compare the outcome of GPi DBS versus Vim/Vop DBS versus both.
Method: Three years after suffering a left-sided putaminal stroke due to a heart aneurysm at the age of six, the patient developed a right-sided hemidystonia. At age 22 left sided Vim/Vop and GPi DBS were implanted in a single surgical procedure. Programming was blinded to the patient and examiner and each possible combination of stimulation (GPi only, Vim/Vop only, GPi and Vim/Vop) was tested. After 3 months of stimulation in each setting, the BFMDRS and SF-36 (quality of life) were completed.
Results: Simultaneous GPi and Vim/Vop stimulation was preferred by the patient and resulted in the best functional improvement measured by the BFMDRS and the best improvement in quality of life as measured by the SF-36. Vim/Vop or GPi stimulation alone slightly improved QoL and was felt by the patient to be subjectively better than their baseline but did not result in improvement of dystonia as rated by the BFMDRS.
Conclusions: Simultaneous thalamic and pallidal DBS proved to be the most effective therapy for this patient suffering from secondary hemidystonia due to a putaminal stroke. Multifocal DBS should be considered for post-stroke dystonia and may offer improved outcome in other forms of secondary dystonia with limited response to GPi DBS.
