Clinical outcome and intraoperative neurophysiology for focal limb dystonic tremor without generalized dystonia treated with deep brain stimulation

2016 ◽  
Vol 150 ◽  
pp. 169-176 ◽  
Author(s):  
Adolfo Ramirez-Zamora ◽  
Brian Kaszuba ◽  
Lucy Gee ◽  
Julia Prusik ◽  
Eric Molho ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Brain Stimulation ◽  
Intraoperative Neurophysiology ◽  
Dystonic Tremor ◽  
Generalized Dystonia ◽  
Deep Brain

Choosing a Target for Deep Brain Stimulation in Dystonia-Associated Tremor

2020 ◽  
pp. 195-200
Author(s):  
Mustafa S. Siddiqui ◽  
Stephen B. Tatter
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
Cervical Dystonia ◽  
Systematic Approach ◽  
Favorable Outcome ◽  
Dystonic Tremor ◽  
Generalized Dystonia ◽  
Deep Brain

This chapter presents a case of medication-refractory primary generalized dystonia presenting with disabling symptoms of cervical dystonia and dystonic bilateral arm tremors. This case posed a challenge in the choice of the appropriate target for deep brain stimulation (DBS) because the targeting of the globus pallidus interna improves dystonia symptoms but may have a less predictable response to tremor. DBS targeting the ventral intermedius may not in many cases improve dystonia symptoms but can effectively control tremor. The authors describe a case in which they employed a systematic approach including implanting multiple leads in different DBS targets. This approach resulted in a favorable outcome for this patient in dystonia and in dystonic tremor.

Deep Brain Stimulation Targeting the Globus Pallidus Interna for Dystonic Tremor in the Setting of Generalized Dystonia

2020 ◽  
pp. 205-208
Author(s):  
Qiang Zhang ◽  
Teri R. Thomsen
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
High Frequency ◽  
Pulse Width ◽  
Low Frequency ◽  
Good Control ◽  
Dystonic Tremor ◽  
Generalized Dystonia ◽  
Deep Brain

Intractable generalized dystonia can be treated by deep brain stimulation (DBS) targeting the globus pallidus interna (GPi). The GPi DBS parameters used for generalized dystonia are frequently different from those used for Parkinson disease, with low-frequency, high–pulse width stimulation being common. This chapter presents a patient with generalized dystonia and debilitating dystonic tremor involving the bilateral hands. He could not tolerate higher pulse width than 60 µsec, but high-frequency (130-Hz) stimulation achieved good control of the dystonic tremor as well as of the generalized dystonia. DBS therapy improved his qualify of life. For generalized dystonia and coexisting dystonic tremor, the tremor may in some cases respond to high-frequency GPi DBS.

Mapping efficacious deep brain stimulation for pediatric dystonia

2021 ◽  
pp. 1-11
Author(s):  
Ailish Coblentz ◽  
Gavin J. B. Elias ◽  
Alexandre Boutet ◽  
Jurgen Germann ◽  
Musleh Algarni ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Brain Stimulation ◽  
Pediatric Patients ◽  
Rating Scale ◽  
Structural Connectivity ◽  
Response To Treatment ◽  
Internal Globus Pallidus ◽  
Probabilistic Map ◽  
Deep Brain

OBJECTIVEThe objective of this study was to report the authors’ experience with deep brain stimulation (DBS) of the internal globus pallidus (GPi) as a treatment for pediatric dystonia, and to elucidate substrates underlying clinical outcome using state-of-the-art neuroimaging techniques.METHODSA retrospective analysis was conducted in 11 pediatric patients (6 girls and 5 boys, mean age 12 ± 4 years) with medically refractory dystonia who underwent GPi-DBS implantation between June 2009 and September 2017. Using pre- and postoperative MRI, volumes of tissue activated were modeled and weighted by clinical outcome to identify brain regions associated with clinical outcome. Functional and structural networks associated with clinical benefits were also determined using large-scale normative data sets.RESULTSA total of 21 implanted leads were analyzed in 11 patients. The average follow-up duration was 19 ± 20 months (median 5 months). Using a 7-point clinical rating scale, 10 patients showed response to treatment, as defined by scores < 3. The mean improvement in the Burke-Fahn-Marsden Dystonia Rating Scale motor score was 40% ± 23%. The probabilistic map of efficacy showed that the voxel cluster most associated with clinical improvement was located at the posterior aspect of the GPi, comparatively posterior and superior to the coordinates of the classic GPi target. Strong functional and structural connectivity was evident between the probabilistic map and areas such as the precentral and postcentral gyri, parietooccipital cortex, and brainstem.CONCLUSIONSThis study reported on a series of pediatric patients with dystonia in whom GPi-DBS resulted in variable clinical benefit and described a clinically favorable stimulation site for this cohort, as well as its structural and functional connectivity. This information could be valuable for improving surgical planning, simplifying programming, and further informing disease pathophysiology.

Subthalamic nucleus deep brain stimulation after bilateral pallidotomy in the treatment of generalized dystonia

2014 ◽  
Vol 20 (1) ◽  
pp. 131-133 ◽  
Author(s):  
Malgorzata Dec ◽  
Marcin Tutaj ◽  
Monika Rudzińska ◽  
Andrzej Szczudlik ◽  
Henryk Koziara ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Generalized Dystonia ◽  
Deep Brain

scholarly journals Deep brain stimulation treatment in dystonia: a bibliometric analysis

2020 ◽  
Vol 78 (9) ◽  
pp. 586-592
Author(s):  
Clarice LISTIK ◽  
Eduardo LISTIK ◽  
Rubens Gisbert CURY ◽  
Egberto Reis BARBOSA ◽  
Manoel Jacobsen TEIXEIRA ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Bibliometric Analysis ◽  
Brain Stimulation ◽  
The United States ◽  
Scientific Journals ◽  
Long Term Outcomes ◽  
Generalized Dystonia ◽  
Research Domain ◽  
Deep Brain

ABSTRACT Background: Dystonia is a heterogeneous disorder that, when refractory to medical treatment, may have a favorable response to deep brain stimulation (DBS). A practical way to have an overview of a research domain is through a bibliometric analysis, as it makes it more accessible for researchers and others outside the field to have an idea of its directions and needs. Objective: To analyze the 100 most cited articles in the use of DBS for dystonia treatment in the last 30 years. Methods: The research protocol was performed in June 2019 in Elsevier’s Scopus database, by retrieving the most cited articles regarding DBS in dystonia. We analyzed authors, year of publication, country, affiliation, and targets of DBS. Results: Articles are mainly published in Movement Disorders (19%), Journal of Neurosurgery (9%), and Neurology (9%). European countries offer significant contributions (57% of our sample). France (192.5 citations/paper) and Germany (144.1 citations/paper) have the highest citation rates of all countries. The United States contributes with 31% of the articles, with 129.8 citations/paper. The publications are focused on General outcomes (46%), followed by Long-term outcomes (12.5%), and Complications (11%), and the leading type of dystonia researched is idiopathic or inherited, isolated, segmental or generalized dystonia, with 27% of articles and 204.3 citations/paper. Conclusions: DBS in dystonia research is mainly published in a handful of scientific journals and focused on the outcomes of the surgery in idiopathic or inherited, isolated, segmental or generalized dystonia, and with globus pallidus internus as the main DBS target.

Freezing of Gait After Bilateral Globus Pallidus Interna Deep Brain Stimulation in Generalized Dystonia

2020 ◽  
pp. 105-108
Author(s):  
Mariana Moscovich
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
Freezing Of Gait ◽  
Left Handed ◽  
Old Left ◽  
Generalized Dystonia ◽  
Walking Difficulty ◽  
Deep Brain

Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a safe and long-term effective treatment for medication-refractory dystonia. However, complications and side effects may occur. Freezing of gait (FOG) is a rare phenomenon in patients with dystonia, although very frequently this complication is observed in patients with Parkinson disease (PD). FOG can be disabling and may severely impair quality of life, even when episodic. This chapter reports on a case of a 49-year-old left-handed man presenting with FOG, impairment in balance, and walking difficulty. These issues emerged 3 years after successful bilateral GPi DBS for primary generalized dystonia.

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