Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-23T23:48:22.107Z Has data issue: false hasContentIssue false
  • English
  • Français

Pallidal Deep Brain Stimulation in Cervical Dystonia: Clinical Outcome in Four Cases

Published online by Cambridge University Press:  02 December 2014

H.A. Eltahawy ,
J. Saint-Cyr ,
Y.Y. Poon ,
E. Moro ,
A.E. Lang  and
A.M. Lozano
H.A. Eltahawy
Affiliation:
Toronto Western Hospital, Division of Neurosurgery, Toronto, Ontario, Canada and the Ain Shams University Hospitals, Neurosurgery Department, Cairo, Egypt
J. Saint-Cyr
Affiliation:
Toronto Western Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
Y.Y. Poon
Affiliation:
Toronto Western Hospital, Neurology Department, Toronto, Ontario, Canada
E. Moro
Affiliation:
Toronto Western Hospital, Neurology Department, Toronto, Ontario, Canada
A.E. Lang
Affiliation:
Toronto Western Hospital, Neurology Department, Toronto, Ontario, Canada
A.M. Lozano
Affiliation:
Toronto Western Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Report on the clinical results following bilateral globus pallidus interna deep brain stimulation in four patients (one female and three males) with severe cervical dystonia, mean age 48 years (range 37-67).

Methods:

All four patients had failed extensive medical and botulinum toxin treatment. The mean duration of the disease was nine years (range 4-15 years). Patients were assessed pre and postoperatively using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Preoperatively, the mean TWSTRS total score was 43.2 (range 28-60.5). Posteroventral pallidal deep brain stimulators were inserted using MRI and microelectrode recording guidance. Last follow-up was 15 months for the four patients.

Results:

Mean reduction in the TWSTRS total scores at last follow- up was 73% (range 61- 85%). Improvement in pain occurred soon after deep brain stimulation surgery. Motor improvement was delayed and prolonged over several months. Frequent adjustment in the stimulation parameters was necessary in the first three months.

Conclusion:

Bilateral pallidal stimulation is effective in management of selected cases of intractable cervical dystonia.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 3 , August 2004 , pp. 328 - 332
Copyright
Copyright © The Canadian Journal of Neurological 2004

References

1.Dauer, WT, Burke, RE, Greene, P, Fahn, S.Current concepts on the clinical features, aetiology and management of idiopathic cervical dystonia. Brain 1998; 121(Pt 4): 547–560.Google Scholar
2.Fahn, S, Marsden, C, Calne, DB.Clarification and investigation of dystonia. In: Fahn, S, (Ed). Movemement Disorders. London: Butterworth Int Med Rev 1987; 323–361.Google Scholar
3.Claypool, DW, Duane, DD, Ilstrup, DM, Melton, LJ, 3rd. Epidemiology and outcome of cervical dystonia (spasmodic torticollis) in Rochester, Minnesota. Mov Disord 1995; 10(5): 608–614.CrossRefGoogle ScholarPubMed
4.Jankovic, J, Schwartz, K.Response and immunoresistance to botulinum toxin injections. Neurology 1995; 45(9): 1743–1746.CrossRefGoogle ScholarPubMed
5.Anderson, T.Spasmodic torticollis. In: Moore, P, (Ed). Handbook of Botulinum Toxin Treatment. Oxford: Blackwell Science, 1995; 103–130.Google Scholar
6.Villavicencio, AT, Friedman, AH.Surgery for Spasmodic Torticollis. In: Lozano, AM, (Ed). Movement Disorder Surgery, vol 15. Basel: Karger, 2000; 296–330.Google Scholar
7.Lang, AE.Surgical treatment of dystonia. Adv Neurol 1998; 78: 185–198.Google Scholar
8.Hassler, R, Hess, WR.Experimentelle und anatomische befunde uber die drehbewegungen and ihrenervosen apparate. Arch Psychiatr Nervenkr 1954; 192: 488–526.CrossRefGoogle Scholar
9.von Essen, C, Augustinsson, LE, Lindqvist G. VOI thalamotomy in spasmodic torticollis. Appl Neurophysiol 1980; 43(3-5): 159–163.Google Scholar
10.Laitinen, LV, Vilkki, J.Observations on physiological and psychological functions of the ventral oral internal nucleus of the human thalamus. Acta Neurol Scand 1977; 55(3): 198–212.CrossRefGoogle ScholarPubMed
11.Cooper, IS.Neurosurgical treatment of the dyskinesias. Clin Neurosurg 1977; 24: 367–390.Google Scholar
12.Andrew, J, Fowler, CJ, Harrison, MJ.Stereotaxic thalamotomy in 55 cases of dystonia. Brain 1983; 106 (Pt 4): 981–1000.Google Scholar
13.Eidelberg, D, Moeller, JR, Antonini, A, et al.Functional brain networks in DYT1 dystonia. Ann Neurol 1998; 44(3): 303–312.Google Scholar
14.Vitek, JL, Zhang, J, Evatt, M, et al.GPi pallidotomy for dystonia: clinical outcome and neuronal activity. Adv Neurol 1998; 78: 211–219.Google ScholarPubMed
15.Lenz, FA, Suarez, JI, Metman, LV, et al.Pallidal activity during dystonia: somatosensory reorganisation and changes with severity. J Neurol Neurosurg Psychiatry 1998; 65(5): 767–770.Google Scholar
16.Lin, JJ, Lin, GY, Shih, C, et al.Benefit of bilateral pallidotomy in the treatment of generalized dystonia. Case report. J Neurosurg 1999; 90(5): 974–976.Google Scholar
17.Iacono, RP, Kuniyoshi, SM, Lonser, RR, et al.Simultaneous bilateral pallidoansotomy for idiopathic dystonia musculorum deformans. Pediatr Neurol 1996; 14(2): 145–148.Google Scholar
18.Lozano, AM, Kumar, R, Gross, RE, et al.Globus pallidus internus pallidotomy for generalized dystonia. Mov Disord 1997; 12(6): 865–870.Google Scholar
19.Yoshor, D, Hamilton, WJ, Ondo, W, Jankovic, J, Grossman, RG.Comparison of thalamotomy and pallidotomy for the treatment of dystonia. Neurosurgery 2001; 48(4): 818–824.Google Scholar
20.Eltahawy, HA, Saint-Cyr, J, Giladi, N, Lang, AE, Lozano, AM.Primary dystonia is more responsive than seconday dystonia to pallidal interventions: outcome after pallidotomy or pallidal deep brain stimulation. Neurosurgery 2004; 54(3): 613–619.CrossRefGoogle ScholarPubMed
21.Tarsy, D.Comparison of clinical rating scales in treatment of cervical dystonia with botulinum toxin. Mov Disord 1997; 12(1): 100–102.Google Scholar
22.Lindeboom, R, Brans, JW, Aramideh, M, Speelman, HD, De Haan, RJ.Treatment of cervical dystonia: a comparison of measures for outcome assessment. Mov Disord 1998; 13(4): 706–712.Google Scholar
23.Comella, CL, Stebbins, GT, Goetz, CG, et al.Teaching tape for the motor section of the Toronto Western Spasmodic Torticollis Scale. Mov Disord 1997; 12(4): 570–575.Google Scholar
24.Lozano, A, Hutchison, W, Kiss, Z, et al.Methods for microelectrode-guided posteroventral pallidotomy. J Neurosurg 1996; 84(2): 194–202.Google Scholar
25.Krauss, JK, Pohle, T, Weber, S, Ozdoba, C, Burgunder, JM.Bilateral stimulation of globus pallidus internus for treatment of cervical dystonia. Lancet 1999; 354(9181): 837–838.Google Scholar
26.Kulisevsky, J, Lleo, A, Gironell, A, et al.Bilateral pallidal stimulation for cervical dystonia: dissociated pain and motor improvement. Neurology 2000; 55(11): 1754–1755.Google Scholar
27.Islekel, S, Zileli, M, Zileli, B.Unilateral pallidal stimulation in cervical dystonia. Stereotact Funct Neurosurg 1999; 72(2-4): 248–252.Google Scholar
28.Parkin, S, Aziz, T, Gregory, R, Bain, P.Bilateral internal globus pallidus stimulation for the treatment of spasmodic torticollis. Mov Disord 2001; 16(3): 489–493.CrossRefGoogle ScholarPubMed
29.Andaluz, N, Taha, JM, Dalvi, A.Bilateral pallidal deep brain stimulation for cervical and truncal dystonia. Neurology 2001; 57(3): 557–558.CrossRefGoogle ScholarPubMed
30.Bereznai, B, Steude, U, Seelos, K, Bozel, K.Chronic high-frequency globus pallidus internus stimulation in different types of dystonia: a clinical, video, and MRI report of six patients presenting with segmental, cervical, and generalized dystonia. Mov Disord 2002; 17(No 1): 138–144.Google Scholar
31.Krauss, JK, Loher, TJ, Pohle, T, et al.Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy. J Neurol Neurosurg Psychiatry 2002; 72(2): 249–256.Google Scholar