Document Detail

A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia.
MedLine Citation:
PMID:  24116723     Owner:  NLM     Status:  MEDLINE    
OBJECT: The authors' aim was to compare the subthalamic nucleus (STN) with the globus pallidus internus (GPi) as a stimulation target for deep brain stimulation (DBS) for medically refractory dystonia.
METHODS: In a prospective double-blind crossover study, electrodes were bilaterally implanted in the STN and GPi of 12 patients with focal, multifocal, or generalized dystonia. Each patient was randomly selected to undergo initial bilateral stimulation of either the STN or the GPi for 6 months, followed by bilateral stimulation of the other nucleus for another 6 months. Preoperative and postoperative ratings were assessed by using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and video recordings. Quality of life was evaluated by using questionnaires (36-item Short Form Health Survey). Supplemental Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed for patients with focal dystonia (torticollis) by examining the video recordings.
RESULTS: On average for all patients, DBS improved the BFMDRS movement scores (p < 0.05) and quality of life physical scores (p < 0.01). After stimulation of the STN, the mean 6-month improvement in BFMDRS movement score was 13.8 points; after stimulation of the GPi, this improvement was 9.1 points (p = 0.08). Quality of life did not differ significantly regardless of which nucleus was stimulated. All 12 patients accepted 6 months of stimulation of the STN, but only 7 accepted 6 months of stimulation of the GPi. Among those who rejected stimulation of the GPi, 3 accepted concomitant stimulation of both the STN and GPi for 6 months, resulting in improved quality of life physical and mental scores and BFMDRS movement scores. Among the 4 patients who were rated according to TWSTRS, after 6 months of stimulation of both the STN and GPi, TWSTRS scores improved by 4.7% after stimulation of the GPi and 50.8% after stimulation of the STN (p = 0.08).
CONCLUSIONS: The STN seems to be a well-accepted, safe, and promising stimulation target in the treatment of dystonia, but further studies are necessary before the optimal target can be concluded. Simultaneous stimulation of the STN and GPi should be further investigated. Clinical trial registration no.: KF 01-110/01 (Committees on Biomedical Research Ethics of the Capital Region of Denmark).
Lisbeth Schjerling; Lena E Hjermind; Bo Jespersen; Flemming F Madsen; Jannick Brennum; Steen R Jensen; Annemette Løkkegaard; Merete Karlsborg
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2013-10-11
Journal Detail:
Title:  Journal of neurosurgery     Volume:  119     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-02     Completed Date:  2014-02-24     Revised Date:  2014-07-15    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1537-45     Citation Subset:  AIM; IM    
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MeSH Terms
Age of Onset
Cross-Over Studies
Deep Brain Stimulation / instrumentation,  methods*
Double-Blind Method
Dystonia / physiopathology,  surgery,  therapy*
Electrodes, Implanted / utilization
Globus Pallidus / physiopathology*,  surgery
Middle Aged
Prospective Studies
Quality of Life
Severity of Illness Index
Subthalamic Nucleus / physiopathology*,  surgery
Torticollis / physiopathology,  therapy
Treatment Outcome
Comment In:
J Neurosurg. 2014 Jun;120(6):1496-7   [PMID:  24977295 ]
J Neurosurg. 2014 Jun;120(6):1496-7   [PMID:  24724852 ]
Erratum In:
J Neurosurg. 2014 Jan;120(1):295

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