Document Detail

Effect of electrode contact location on clinical efficacy of pallidal deep brain stimulation in primary generalised dystonia.
MedLine Citation:
PMID:  17442760     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine the effect of electrode contact location on efficacy of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) for primary generalised dystonia (PGD).
SUBJECTS AND METHODS: A consecutive series of 15 patients with PGD (10 females, mean age 42 years, seven DYT1) who underwent bilateral GPi DBS, were assessed using the Burke-Fahn-Marsden (BFM) dystonia scale before and 6 months after surgery. The position of the stimulated electrode contact(s) was determined from the postoperative stereotactic MRI. Contralateral limb and total axial BFM subscores were compared with the location of the stimulated contact(s) within the GPi.
RESULTS: The mean total BFM score decreased from 38.9 preoperatively to 11.9 at 6 months, an improvement of 69.5% (p<0.00001). Cluster analysis of the stimulated contact coordinates identified two groups, distributed along an anterodorsal to posteroventral axis. Clinical improvement was greater for posteroventral than anterodorsal stimulation for the arm (86% vs 52%; p<0.05) and trunk (96% vs 65%; p<0.05) and inversely correlated with the y coordinate. For the leg, posteroventral and anterodorsal stimulation were of equivalent efficacy. Overall clinical improvement was maximal with posteroventral stimulation (89% vs 67%; p<0.05) and inversely correlated with the y (A-P) coordinate (r = -0.62, p<0.05).
CONCLUSION: GPi DBS is effective for PGD but outcome is dependent on contact location. Posteroventral GPi stimulation provides the best overall effect and is superior for the arm and trunk. These results may be explained by the functional anatomy of GPi and its outflow tracts.
S Tisch; L Zrinzo; P Limousin; K P Bhatia; N Quinn; K Ashkan; M Hariz
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-04-18
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  78     ISSN:  1468-330X     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-20     Completed Date:  2007-12-10     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  England    
Other Details:
Languages:  eng     Pagination:  1314-9     Citation Subset:  IM    
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MeSH Terms
Deep Brain Stimulation / instrumentation*
Dystonic Disorders / diagnosis,  surgery*
Electrodes, Implanted
Functional Laterality / physiology
Globus Pallidus / pathology,  surgery*
Magnetic Resonance Imaging
Severity of Illness Index
Stereotaxic Techniques / instrumentation

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

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