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Clin Neurol Neurosurg. 2015 Nov;138:16-9. doi: 10.1016/j.clineuro.2015.07.012. Epub 2015 Jul 29.

A prospective, randomized, blinded assessment of multitarget thalamic and pallidal deep brain stimulation in a case of hemidystonia.

Author information

1
Division of Neurosurgery, University of British Columbia, Vancouver, Canada; Department of Stereotactic and Functional Neurosurgery, Heinrich-Heine University, Düsseldorf, Germany.
2
Division of Neurosurgery, University of British Columbia, Vancouver, Canada.
3
Division of Neurosurgery, University of British Columbia, Vancouver, Canada. Electronic address: chris.honey@telus.net.

Abstract

OBJECTIVE:

Dystonia is increasingly being interpreted as a multi-nodal "network" disorder. We aimed to investigate multitarget DBS (pallidal and thalamic) versus each target alone in a prospective, randomized, blinded trial in a case of hemidystonia secondary to putaminal stroke.

METHODS:

DBS leads were implanted in the GPi and Vim/Vop and each stimulation combination (GPi, Vim/Vop, and both) was tested for three months in a single patient. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Short-Form 36 (SF-36) were completed at the end of each trial period.

RESULTS:

Multitarget (GPi+Vim/Vop) stimulation was clinically the most effective treatment and resulted in the most improvement in function and quality of life. The patient's hemidystonia improved by 25% as measured by the BFMDRS during the multitarget stimulation trial period and at the 6-month follow-up. The patient's quality of life improved by 86% and 59% during the multitarget stimulation trial period and at the 6 month follow-up respectively.

CONCLUSION:

Multitarget thalamic and pallidal DBS proved to be the most effective therapy for this patient with secondary hemidystonia due to a putaminal stroke. A single-lead approach may not be sufficient in neuromodulating a highly disorganized motor network seen in hemidystonia. Multitarget DBS should be further explored in post-stroke dystonia and may offer improved outcome in other forms of secondary dystonia with limited response to GPi DBS.

KEYWORDS:

Deep brain stimulation; Hemidystonia; Multitarget; Pallidal; Secondary dystonia; Thalamic

PMID:
26241157
DOI:
10.1016/j.clineuro.2015.07.012
[Indexed for MEDLINE]

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