Document Detail


Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia.
MedLine Citation:
PMID:  15689584     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Severe forms of dystonia respond poorly to medical treatment. Deep-brain stimulation is a reversible neurosurgical procedure that has been used for the treatment of dystonia, but assessment of its efficacy has been limited to open studies. METHODS: We performed a prospective, controlled, multicenter study assessing the efficacy and safety of bilateral pallidal stimulation in 22 patients with primary generalized dystonia. The severity of dystonia was evaluated before surgery and 3, 6, and 12 months postoperatively during neurostimulation, with the use of the movement and disability subscores of the Burke-Fahn-Marsden Dystonia Scale (range, 0 to 120 and 0 to 30, respectively, with higher scores indicating greater impairment). Movement scores were assessed by a review of videotaped sessions performed by an observer who was unaware of treatment status. At three months, patients underwent a double-blind evaluation in the presence and absence of neurostimulation. We also assessed the patients' quality of life, cognition, and mood at baseline and 12 months. RESULTS: The dystonia movement score improved from a mean (+/-SD) of 46.3+/-21.3 before surgery to 21.0+/-14.1 at 12 months (P<0.001). The disability score improved from 11.6+/-5.5 before surgery to 6.5+/-4.9 at 12 months (P<0.001). General health and physical functioning were significantly improved at month 12; there were no significant changes in measures of mood and cognition. At the three-month evaluation, dystonia movement scores were significantly better with neurostimulation than without neurostimulation (24.6+/-17.7 vs. 34.6+/-12.3, P<0.001). There were five adverse events (in three patients); all resolved without permanent sequelae. CONCLUSIONS: These findings support the efficacy and safety of the use of bilateral stimulation of the internal globus pallidus in selected patients with primary generalized dystonia.
Authors:
Marie Vidailhet; Laurent Vercueil; Jean-Luc Houeto; Pierre Krystkowiak; Alim-Louis Benabid; Philippe Cornu; Christelle Lagrange; Sophie Tézenas du Montcel; Didier Dormont; Sylvie Grand; Serge Blond; Olivier Detante; Bernard Pillon; Claire Ardouin; Yves Agid; Alain Destée; Pierre Pollak;
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  352     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-02-03     Completed Date:  2005-02-08     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  459-67     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2005 Massachusetts Medical Society.
Affiliation:
Department of Neurology, Saint Antoine Hospital, Paris, France. marie.vidailhet@sat.ap-hop-paris.fr
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Benzodiazepines / therapeutic use
Cholinergic Antagonists / therapeutic use
Combined Modality Therapy
Deep Brain Stimulation* / adverse effects
Double-Blind Method
Dystonia / drug therapy,  therapy*
Electrodes, Implanted
Female
Globus Pallidus* / surgery
Humans
Male
Middle Aged
Prospective Studies
Quality of Life
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cholinergic Antagonists; 12794-10-4/Benzodiazepines
Comments/Corrections
Comment In:
N Engl J Med. 2005 Feb 3;352(5):498-500   [PMID:  15689590 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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