Dual Pallidal and Thalamic Deep Brain Stimulation for Complex Ipsilateral Dystonia
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Purpose: Globus pallidus pars interna (GPi) has become an established target for deep brain stimulation (DBS) in dystonia. Previousstudies suggest that targeting the ventralis oralis (Vo) complex nucleus improves dystonic tremor or even focal dystonia. Researchhas also demonstrated that multi-target DBS shows some benefits over single target DBS. In this study, we reviewed patientswho had undergone unilateral DBS targeting the GPi and Vo. Materials and Methods: Five patients diagnosed with medically refractory upper extremity dystonia (focal or segmental) underwentDBS. Two DBS electrodes each were inserted unilaterally targeting the ipsilateral GPi and Vo. Clinical outcomes were evaluatedusing the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Disability Rating Scale. Results: BFMDRS scores decreased by 55% at 1-month, 56% at 3-month, 59% at 6-month, and 64% at 12-month follow up. DisabilityRating Scale scores decreased 41% at 1-month, 47% at 3-month, 50% at 6-month, and 60% at 12-month follow up. At 1 monthafter surgery, stimulating both targets improved clinical scores better than targeting GPi or Vo alone. Conclusion: Unilateral thalamic and pallidal dual electrode DBS may be as effective or even superior to DBS of a single target fordystonia. Although the number of patients was small, our results reflected favorable clinical outcomes.
Abstract
Purpose: Globus pallidus pars interna (GPi) has become an established target for deep brain stimulation (DBS) in dystonia. Previousstudies suggest that targeting the ventralis oralis (Vo) complex nucleus improves dystonic tremor or even focal dystonia. Researchhas also demonstrated that multi-target DBS shows some benefits over single target DBS. In this study, we reviewed patientswho had undergone unilateral DBS targeting the GPi and Vo. Materials and Methods: Five patients diagnosed with medically refractory upper extremity dystonia (focal or segmental) underwentDBS. Two DBS electrodes each were inserted unilaterally targeting the ipsilateral GPi and Vo. Clinical outcomes were evaluatedusing the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Disability Rating Scale. Results: BFMDRS scores decreased by 55% at 1-month, 56% at 3-month, 59% at 6-month, and 64% at 12-month follow up. DisabilityRating Scale scores decreased 41% at 1-month, 47% at 3-month, 50% at 6-month, and 60% at 12-month follow up. At 1 monthafter surgery, stimulating both targets improved clinical scores better than targeting GPi or Vo alone. Conclusion: Unilateral thalamic and pallidal dual electrode DBS may be as effective or even superior to DBS of a single target fordystonia. Although the number of patients was small, our results reflected favorable clinical outcomes.
참고문헌 (30)
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