Bilateral Deep Brain Stimulation for Cervical Dystonia: Long-term Outcome in a Series of 10 Patients
Abstract BACKGROUND: Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) was shown to be effective in cervical dystonia refractory to medical treatment in several small short-term and 1 long-term follow-up series. Optimal stimulation parameters and their repercussions on the cost/b...
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| Veröffentlicht in: | Neurosurgery 2010-10, Vol.67 (4), p.957-963 |
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| creator | Cacciola, Francesco Farah, Jibril Osman Eldridge, Paul R Byrne, Patricia Varma, Telekath K |
| description | Abstract
BACKGROUND:
Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) was shown to be effective in cervical dystonia refractory to medical treatment in several small short-term and 1 long-term follow-up series. Optimal stimulation parameters and their repercussions on the cost/benefit ratio still need to be established.
OBJECTIVE:
To report our long-term outcome with bilateral GPi deep brain stimulation in cervical dystonia.
METHODS:
The Toronto Western Spasmodic Torticollis Rating Scale was evaluated in 10 consecutive patients preoperatively and at last follow-up. The relationship of improvement in postural severity and pain was analyzed and stimulation parameters noted and compared with those in a similar series in the literature.
RESULTS:
The mean (standard deviation) follow-up was 37.6 (16.9) months. Improvement in the total Toronto Western Spasmodic Torticollis Rating Scale score as evaluated at latest follow-up was 68.1% (95% confidence interval: 51.5-84.6). In 4 patients, there was dissociation between posture severity and pain improvement. Prevalently bipolar stimulation settings and high pulse widths and amplitudes led to excellent results at the expense of battery life.
CONCLUSION:
Improvement in all 3 subscale scores of the Toronto Western Spasmodic Torticollis Rating Scale with bilateral GPi deep brain stimulation seems to be the rule. Refinement of stimulation parameters might have a significant impact on the cost/benefit ratio of the treatment. The dissociation of improvement in posture severity and pain provides tangible evidence of the complex nature of cervical dystonia and offers interesting insight into the complex functional organization of the GPi. |
| doi_str_mv | 10.1227/NEU.0b013e3181ec49c7 |
| format | Article |
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BACKGROUND:
Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) was shown to be effective in cervical dystonia refractory to medical treatment in several small short-term and 1 long-term follow-up series. Optimal stimulation parameters and their repercussions on the cost/benefit ratio still need to be established.
OBJECTIVE:
To report our long-term outcome with bilateral GPi deep brain stimulation in cervical dystonia.
METHODS:
The Toronto Western Spasmodic Torticollis Rating Scale was evaluated in 10 consecutive patients preoperatively and at last follow-up. The relationship of improvement in postural severity and pain was analyzed and stimulation parameters noted and compared with those in a similar series in the literature.
RESULTS:
The mean (standard deviation) follow-up was 37.6 (16.9) months. Improvement in the total Toronto Western Spasmodic Torticollis Rating Scale score as evaluated at latest follow-up was 68.1% (95% confidence interval: 51.5-84.6). In 4 patients, there was dissociation between posture severity and pain improvement. Prevalently bipolar stimulation settings and high pulse widths and amplitudes led to excellent results at the expense of battery life.
CONCLUSION:
Improvement in all 3 subscale scores of the Toronto Western Spasmodic Torticollis Rating Scale with bilateral GPi deep brain stimulation seems to be the rule. Refinement of stimulation parameters might have a significant impact on the cost/benefit ratio of the treatment. The dissociation of improvement in posture severity and pain provides tangible evidence of the complex nature of cervical dystonia and offers interesting insight into the complex functional organization of the GPi.</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/NEU.0b013e3181ec49c7</identifier><identifier>PMID: 20881561</identifier><identifier>CODEN: NRSRDY</identifier><language>eng</language><publisher>Hagerstown, MD: Oxford University Press</publisher><subject>Adult ; Biological and medical sciences ; Deep brain stimulation ; Deep Brain Stimulation - methods ; Female ; Globus Pallidus - physiology ; Humans ; Longitudinal Studies ; Magnetic Resonance Imaging - methods ; Male ; Medical sciences ; Middle Aged ; Neurosurgery ; Pain ; Retrospective Studies ; Statistics, Nonparametric ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Time Factors ; Torticollis - therapy ; Treatment Outcome</subject><ispartof>Neurosurgery, 2010-10, Vol.67 (4), p.957-963</ispartof><rights>Copyright © 2010 by the Congress of Neurological Surgeons</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-b66d6a8daf057dd305824298cbc22e32f82593a0642ef18f9cf3fc2b3e52ae4a3</citedby><cites>FETCH-LOGICAL-c470t-b66d6a8daf057dd305824298cbc22e32f82593a0642ef18f9cf3fc2b3e52ae4a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23268800$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20881561$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cacciola, Francesco</creatorcontrib><creatorcontrib>Farah, Jibril Osman</creatorcontrib><creatorcontrib>Eldridge, Paul R</creatorcontrib><creatorcontrib>Byrne, Patricia</creatorcontrib><creatorcontrib>Varma, Telekath K</creatorcontrib><title>Bilateral Deep Brain Stimulation for Cervical Dystonia: Long-term Outcome in a Series of 10 Patients</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>Abstract
BACKGROUND:
Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) was shown to be effective in cervical dystonia refractory to medical treatment in several small short-term and 1 long-term follow-up series. Optimal stimulation parameters and their repercussions on the cost/benefit ratio still need to be established.
OBJECTIVE:
To report our long-term outcome with bilateral GPi deep brain stimulation in cervical dystonia.
METHODS:
The Toronto Western Spasmodic Torticollis Rating Scale was evaluated in 10 consecutive patients preoperatively and at last follow-up. The relationship of improvement in postural severity and pain was analyzed and stimulation parameters noted and compared with those in a similar series in the literature.
RESULTS:
The mean (standard deviation) follow-up was 37.6 (16.9) months. Improvement in the total Toronto Western Spasmodic Torticollis Rating Scale score as evaluated at latest follow-up was 68.1% (95% confidence interval: 51.5-84.6). In 4 patients, there was dissociation between posture severity and pain improvement. Prevalently bipolar stimulation settings and high pulse widths and amplitudes led to excellent results at the expense of battery life.
CONCLUSION:
Improvement in all 3 subscale scores of the Toronto Western Spasmodic Torticollis Rating Scale with bilateral GPi deep brain stimulation seems to be the rule. Refinement of stimulation parameters might have a significant impact on the cost/benefit ratio of the treatment. The dissociation of improvement in posture severity and pain provides tangible evidence of the complex nature of cervical dystonia and offers interesting insight into the complex functional organization of the GPi.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Deep brain stimulation</subject><subject>Deep Brain Stimulation - methods</subject><subject>Female</subject><subject>Globus Pallidus - physiology</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Pain</subject><subject>Retrospective Studies</subject><subject>Statistics, Nonparametric</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Time Factors</subject><subject>Torticollis - therapy</subject><subject>Treatment Outcome</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkUFr3DAQhUVpaTZp_0EpglJycjIaybbcW7NN28DSBJJAb0aWR0XBtjaSXci_r8JuW8gpp4Hhe2-G9xh7J-BEINanP85vT6ADIUkKLciqxtYv2EqUqAoFCl6yFQilC9lUPw_YYUp3AKJStX7NDhC0FmUlVqw_84OZKZqBfyHa8rNo_MSvZz8uee_DxF2IfE3xt7ePzEOaw-TNJ74J068iC0d-ucw2jMSzzvBrip4SD44L4FfZgaY5vWGvnBkSvd3PI3b79fxm_b3YXH67WH_eFFbVMBddVfWV0b1xUNZ9L6HUqLDRtrOIJNFpLBtpoFJITmjXWCedxU5SiYaUkUfseOe7jeF-oTS3o0-WhsFMFJbU1mWFTaNUmckPT8i7sMQpP9eihLpGzMFmSu0oG0NKkVy7jX408aEV0D6W0OYS2qclZNn7vfnSjdT_E_1NPQMf94BJOVUXzWR9-s9JrLQGyNzpjgvL9nmn_wC5T54X</recordid><startdate>20101001</startdate><enddate>20101001</enddate><creator>Cacciola, Francesco</creator><creator>Farah, Jibril Osman</creator><creator>Eldridge, Paul R</creator><creator>Byrne, Patricia</creator><creator>Varma, Telekath K</creator><general>Oxford University Press</general><general>Lippincott Williams & Wilkins</general><general>Wolters Kluwer Health, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20101001</creationdate><title>Bilateral Deep Brain Stimulation for Cervical Dystonia: Long-term Outcome in a Series of 10 Patients</title><author>Cacciola, Francesco ; Farah, Jibril Osman ; Eldridge, Paul R ; Byrne, Patricia ; Varma, Telekath K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-b66d6a8daf057dd305824298cbc22e32f82593a0642ef18f9cf3fc2b3e52ae4a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Deep brain stimulation</topic><topic>Deep Brain Stimulation - methods</topic><topic>Female</topic><topic>Globus Pallidus - physiology</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Pain</topic><topic>Retrospective Studies</topic><topic>Statistics, Nonparametric</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Time Factors</topic><topic>Torticollis - therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cacciola, Francesco</creatorcontrib><creatorcontrib>Farah, Jibril Osman</creatorcontrib><creatorcontrib>Eldridge, Paul R</creatorcontrib><creatorcontrib>Byrne, Patricia</creatorcontrib><creatorcontrib>Varma, Telekath K</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cacciola, Francesco</au><au>Farah, Jibril Osman</au><au>Eldridge, Paul R</au><au>Byrne, Patricia</au><au>Varma, Telekath K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bilateral Deep Brain Stimulation for Cervical Dystonia: Long-term Outcome in a Series of 10 Patients</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2010-10-01</date><risdate>2010</risdate><volume>67</volume><issue>4</issue><spage>957</spage><epage>963</epage><pages>957-963</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><coden>NRSRDY</coden><abstract>Abstract
BACKGROUND:
Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) was shown to be effective in cervical dystonia refractory to medical treatment in several small short-term and 1 long-term follow-up series. Optimal stimulation parameters and their repercussions on the cost/benefit ratio still need to be established.
OBJECTIVE:
To report our long-term outcome with bilateral GPi deep brain stimulation in cervical dystonia.
METHODS:
The Toronto Western Spasmodic Torticollis Rating Scale was evaluated in 10 consecutive patients preoperatively and at last follow-up. The relationship of improvement in postural severity and pain was analyzed and stimulation parameters noted and compared with those in a similar series in the literature.
RESULTS:
The mean (standard deviation) follow-up was 37.6 (16.9) months. Improvement in the total Toronto Western Spasmodic Torticollis Rating Scale score as evaluated at latest follow-up was 68.1% (95% confidence interval: 51.5-84.6). In 4 patients, there was dissociation between posture severity and pain improvement. Prevalently bipolar stimulation settings and high pulse widths and amplitudes led to excellent results at the expense of battery life.
CONCLUSION:
Improvement in all 3 subscale scores of the Toronto Western Spasmodic Torticollis Rating Scale with bilateral GPi deep brain stimulation seems to be the rule. Refinement of stimulation parameters might have a significant impact on the cost/benefit ratio of the treatment. The dissociation of improvement in posture severity and pain provides tangible evidence of the complex nature of cervical dystonia and offers interesting insight into the complex functional organization of the GPi.</abstract><cop>Hagerstown, MD</cop><pub>Oxford University Press</pub><pmid>20881561</pmid><doi>10.1227/NEU.0b013e3181ec49c7</doi><tpages>7</tpages></addata></record> |
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| ispartof | Neurosurgery, 2010-10, Vol.67 (4), p.957-963 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Biological and medical sciences Deep brain stimulation Deep Brain Stimulation - methods Female Globus Pallidus - physiology Humans Longitudinal Studies Magnetic Resonance Imaging - methods Male Medical sciences Middle Aged Neurosurgery Pain Retrospective Studies Statistics, Nonparametric Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Time Factors Torticollis - therapy Treatment Outcome |
| title | Bilateral Deep Brain Stimulation for Cervical Dystonia: Long-term Outcome in a Series of 10 Patients |
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