Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders
Background Deep brain stimulation (DBS) within the pallidum represents an effective and well-established treatment for isolated dystonia. However, clinical outcome after surgery may be variable with limited response in 10–25% of patients. The effect of lead location on clinical improvement is still...
Gespeichert in:
| Veröffentlicht in: | Journal of neurology 2020-06, Vol.267 (6), p.1663-1671 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1671 |
|---|---|
| container_issue | 6 |
| container_start_page | 1663 |
| container_title | Journal of neurology |
| container_volume | 267 |
| creator | Zittel, Simone Hidding, Ute Trumpfheller, Maria Baltzer, Vanessa Lupici Gulberti, Alessandro Schaper, Miriam Biermann, Maxine Buhmann, Carsten Engel, Andreas K. Gerloff, Christian Westphal, Manfred Stadler, Jana Köppen, Johannes A. Pötter-Nerger, Monika Moll, Christian K. E. Hamel, Wolfgang |
| description | Background
Deep brain stimulation (DBS) within the pallidum represents an effective and well-established treatment for isolated dystonia. However, clinical outcome after surgery may be variable with limited response in 10–25% of patients. The effect of lead location on clinical improvement is still under debate.
Objective
To identify stimulated brain regions associated with the most beneficial clinical outcome in dystonia patients.
Methods
18 patients with cervical and generalized dystonia with chronic DBS of the internal pallidum were investigated. Patients were grouped according to their clinical improvement into responders, intermediate responders and non-responders. Magnetic resonance and computed tomography images were co-registered, and the volume of tissue activated (VTA) with respect to the pallidum of individual patients was analysed.
Results
VTAs in responders (
n
= 11), intermediate responders (
n
= 3) and non-responders (
n
= 4) intersected with the posterior internal (GPi) and external (GPe) pallidum and the subpallidal area. VTA heat maps showed an almost complete overlap of VTAs of responders, intermediate and non-responders. VTA coverage of the GPi was not higher in responders. In contrast, VTAs of intermediate and non-responders covered the GPi to a significantly larger extent in the left hemisphere (
p
|
| doi_str_mv | 10.1007/s00415-020-09753-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7293687</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2412653146</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-59cae6a5bc6f19fcf780fa899977b8b5b91f9d78cd4221384a2758de863a32673</originalsourceid><addsrcrecordid>eNp9kU1rFTEYhYMo9lr9Ay4k4MbNaL4zcSFIqR9Q0IWuwztJpk2ZSa7J3Mqtf76599ZWXQiBLM5zTvK-B6HnlLymhOg3lRBBZUcY6YjRknfXD9CKCs46KqR5iFaEC9JJLsURelLrJSGkb8JjdMQZUZoysUK_vsI0RQ8TngJ4vJ7AhTmkBceE_bYuOUV4u9cqziNOOXUl1HVOPpSKoQTsclogpuDxz7hcNBvsDix5jq7FFkjnAfsw7pFhi-_tT9GjEaYant3ex-j7h9NvJ5-6sy8fP5-8P-uc0GLppHEQFMjBqZGa0Y26JyP0xhith36Qg6Gj8bp3XjBGeS-Aadn70CsOnCnNj9G7Q-56M8zBuzZegcmuS5yhbG2GaP9WUryw5_nKama46ncBr24DSv6xCXWxc6wuTBOkkDfVMi61UKStvqEv_0Ev86akNp5lgjIlORWqUexAuZJrLWG8-wwldtetPXRrW7d23629bqYXf45xZ_ldZgP4AahNalsv92__J_YGPR-yRQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2412653146</pqid></control><display><type>article</type><title>Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Zittel, Simone ; Hidding, Ute ; Trumpfheller, Maria ; Baltzer, Vanessa Lupici ; Gulberti, Alessandro ; Schaper, Miriam ; Biermann, Maxine ; Buhmann, Carsten ; Engel, Andreas K. ; Gerloff, Christian ; Westphal, Manfred ; Stadler, Jana ; Köppen, Johannes A. ; Pötter-Nerger, Monika ; Moll, Christian K. E. ; Hamel, Wolfgang</creator><creatorcontrib>Zittel, Simone ; Hidding, Ute ; Trumpfheller, Maria ; Baltzer, Vanessa Lupici ; Gulberti, Alessandro ; Schaper, Miriam ; Biermann, Maxine ; Buhmann, Carsten ; Engel, Andreas K. ; Gerloff, Christian ; Westphal, Manfred ; Stadler, Jana ; Köppen, Johannes A. ; Pötter-Nerger, Monika ; Moll, Christian K. E. ; Hamel, Wolfgang</creatorcontrib><description>Background
Deep brain stimulation (DBS) within the pallidum represents an effective and well-established treatment for isolated dystonia. However, clinical outcome after surgery may be variable with limited response in 10–25% of patients. The effect of lead location on clinical improvement is still under debate.
Objective
To identify stimulated brain regions associated with the most beneficial clinical outcome in dystonia patients.
Methods
18 patients with cervical and generalized dystonia with chronic DBS of the internal pallidum were investigated. Patients were grouped according to their clinical improvement into responders, intermediate responders and non-responders. Magnetic resonance and computed tomography images were co-registered, and the volume of tissue activated (VTA) with respect to the pallidum of individual patients was analysed.
Results
VTAs in responders (
n
= 11), intermediate responders (
n
= 3) and non-responders (
n
= 4) intersected with the posterior internal (GPi) and external (GPe) pallidum and the subpallidal area. VTA heat maps showed an almost complete overlap of VTAs of responders, intermediate and non-responders. VTA coverage of the GPi was not higher in responders. In contrast, VTAs of intermediate and non-responders covered the GPi to a significantly larger extent in the left hemisphere (
p
< 0.01).
Conclusions
DBS of ventral parts of the posterior GPi, GPe and the adjacent subpallidal area containing pallidothalamic output projections resulted in favourable clinical effects. Of note, non-responders were also stimulated within the same area. This suggests that factors other than mere lead location (e.g., clinical phenotype, genetic background) have determined clinical outcome in the present cohort.</description><identifier>ISSN: 0340-5354</identifier><identifier>EISSN: 1432-1459</identifier><identifier>DOI: 10.1007/s00415-020-09753-z</identifier><identifier>PMID: 32067124</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adult ; Aged ; Clinical outcomes ; Computed tomography ; Deep brain stimulation ; Deep Brain Stimulation - methods ; Dystonia ; Dystonic Disorders - diagnostic imaging ; Dystonic Disorders - genetics ; Dystonic Disorders - therapy ; Electrodes, Implanted ; Female ; Gene mapping ; Globus Pallidus - anatomy & histology ; Globus Pallidus - diagnostic imaging ; Globus Pallidus - surgery ; Hemispheric laterality ; Humans ; Magnetic resonance imaging ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurology ; Neuroradiology ; Neurosciences ; Original Communication ; Outcome Assessment, Health Care ; Pallidum (ventral) ; Patients ; Phenotypes ; Retrospective Studies ; Surgery ; Torticollis - diagnostic imaging ; Torticollis - genetics ; Torticollis - therapy ; Young Adult</subject><ispartof>Journal of neurology, 2020-06, Vol.267 (6), p.1663-1671</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-59cae6a5bc6f19fcf780fa899977b8b5b91f9d78cd4221384a2758de863a32673</citedby><cites>FETCH-LOGICAL-c474t-59cae6a5bc6f19fcf780fa899977b8b5b91f9d78cd4221384a2758de863a32673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00415-020-09753-z$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00415-020-09753-z$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32067124$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zittel, Simone</creatorcontrib><creatorcontrib>Hidding, Ute</creatorcontrib><creatorcontrib>Trumpfheller, Maria</creatorcontrib><creatorcontrib>Baltzer, Vanessa Lupici</creatorcontrib><creatorcontrib>Gulberti, Alessandro</creatorcontrib><creatorcontrib>Schaper, Miriam</creatorcontrib><creatorcontrib>Biermann, Maxine</creatorcontrib><creatorcontrib>Buhmann, Carsten</creatorcontrib><creatorcontrib>Engel, Andreas K.</creatorcontrib><creatorcontrib>Gerloff, Christian</creatorcontrib><creatorcontrib>Westphal, Manfred</creatorcontrib><creatorcontrib>Stadler, Jana</creatorcontrib><creatorcontrib>Köppen, Johannes A.</creatorcontrib><creatorcontrib>Pötter-Nerger, Monika</creatorcontrib><creatorcontrib>Moll, Christian K. E.</creatorcontrib><creatorcontrib>Hamel, Wolfgang</creatorcontrib><title>Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders</title><title>Journal of neurology</title><addtitle>J Neurol</addtitle><addtitle>J Neurol</addtitle><description>Background
Deep brain stimulation (DBS) within the pallidum represents an effective and well-established treatment for isolated dystonia. However, clinical outcome after surgery may be variable with limited response in 10–25% of patients. The effect of lead location on clinical improvement is still under debate.
Objective
To identify stimulated brain regions associated with the most beneficial clinical outcome in dystonia patients.
Methods
18 patients with cervical and generalized dystonia with chronic DBS of the internal pallidum were investigated. Patients were grouped according to their clinical improvement into responders, intermediate responders and non-responders. Magnetic resonance and computed tomography images were co-registered, and the volume of tissue activated (VTA) with respect to the pallidum of individual patients was analysed.
Results
VTAs in responders (
n
= 11), intermediate responders (
n
= 3) and non-responders (
n
= 4) intersected with the posterior internal (GPi) and external (GPe) pallidum and the subpallidal area. VTA heat maps showed an almost complete overlap of VTAs of responders, intermediate and non-responders. VTA coverage of the GPi was not higher in responders. In contrast, VTAs of intermediate and non-responders covered the GPi to a significantly larger extent in the left hemisphere (
p
< 0.01).
Conclusions
DBS of ventral parts of the posterior GPi, GPe and the adjacent subpallidal area containing pallidothalamic output projections resulted in favourable clinical effects. Of note, non-responders were also stimulated within the same area. This suggests that factors other than mere lead location (e.g., clinical phenotype, genetic background) have determined clinical outcome in the present cohort.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Clinical outcomes</subject><subject>Computed tomography</subject><subject>Deep brain stimulation</subject><subject>Deep Brain Stimulation - methods</subject><subject>Dystonia</subject><subject>Dystonic Disorders - diagnostic imaging</subject><subject>Dystonic Disorders - genetics</subject><subject>Dystonic Disorders - therapy</subject><subject>Electrodes, Implanted</subject><subject>Female</subject><subject>Gene mapping</subject><subject>Globus Pallidus - anatomy & histology</subject><subject>Globus Pallidus - diagnostic imaging</subject><subject>Globus Pallidus - surgery</subject><subject>Hemispheric laterality</subject><subject>Humans</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Original Communication</subject><subject>Outcome Assessment, Health Care</subject><subject>Pallidum (ventral)</subject><subject>Patients</subject><subject>Phenotypes</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Torticollis - diagnostic imaging</subject><subject>Torticollis - genetics</subject><subject>Torticollis - therapy</subject><subject>Young Adult</subject><issn>0340-5354</issn><issn>1432-1459</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU1rFTEYhYMo9lr9Ay4k4MbNaL4zcSFIqR9Q0IWuwztJpk2ZSa7J3Mqtf76599ZWXQiBLM5zTvK-B6HnlLymhOg3lRBBZUcY6YjRknfXD9CKCs46KqR5iFaEC9JJLsURelLrJSGkb8JjdMQZUZoysUK_vsI0RQ8TngJ4vJ7AhTmkBceE_bYuOUV4u9cqziNOOXUl1HVOPpSKoQTsclogpuDxz7hcNBvsDix5jq7FFkjnAfsw7pFhi-_tT9GjEaYant3ex-j7h9NvJ5-6sy8fP5-8P-uc0GLppHEQFMjBqZGa0Y26JyP0xhith36Qg6Gj8bp3XjBGeS-Aadn70CsOnCnNj9G7Q-56M8zBuzZegcmuS5yhbG2GaP9WUryw5_nKama46ncBr24DSv6xCXWxc6wuTBOkkDfVMi61UKStvqEv_0Ev86akNp5lgjIlORWqUexAuZJrLWG8-wwldtetPXRrW7d23629bqYXf45xZ_ldZgP4AahNalsv92__J_YGPR-yRQ</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Zittel, Simone</creator><creator>Hidding, Ute</creator><creator>Trumpfheller, Maria</creator><creator>Baltzer, Vanessa Lupici</creator><creator>Gulberti, Alessandro</creator><creator>Schaper, Miriam</creator><creator>Biermann, Maxine</creator><creator>Buhmann, Carsten</creator><creator>Engel, Andreas K.</creator><creator>Gerloff, Christian</creator><creator>Westphal, Manfred</creator><creator>Stadler, Jana</creator><creator>Köppen, Johannes A.</creator><creator>Pötter-Nerger, Monika</creator><creator>Moll, Christian K. E.</creator><creator>Hamel, Wolfgang</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</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>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</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><scope>5PM</scope></search><sort><creationdate>20200601</creationdate><title>Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders</title><author>Zittel, Simone ; Hidding, Ute ; Trumpfheller, Maria ; Baltzer, Vanessa Lupici ; Gulberti, Alessandro ; Schaper, Miriam ; Biermann, Maxine ; Buhmann, Carsten ; Engel, Andreas K. ; Gerloff, Christian ; Westphal, Manfred ; Stadler, Jana ; Köppen, Johannes A. ; Pötter-Nerger, Monika ; Moll, Christian K. E. ; Hamel, Wolfgang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-59cae6a5bc6f19fcf780fa899977b8b5b91f9d78cd4221384a2758de863a32673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Clinical outcomes</topic><topic>Computed tomography</topic><topic>Deep brain stimulation</topic><topic>Deep Brain Stimulation - methods</topic><topic>Dystonia</topic><topic>Dystonic Disorders - diagnostic imaging</topic><topic>Dystonic Disorders - genetics</topic><topic>Dystonic Disorders - therapy</topic><topic>Electrodes, Implanted</topic><topic>Female</topic><topic>Gene mapping</topic><topic>Globus Pallidus - anatomy & histology</topic><topic>Globus Pallidus - diagnostic imaging</topic><topic>Globus Pallidus - surgery</topic><topic>Hemispheric laterality</topic><topic>Humans</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Original Communication</topic><topic>Outcome Assessment, Health Care</topic><topic>Pallidum (ventral)</topic><topic>Patients</topic><topic>Phenotypes</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Torticollis - diagnostic imaging</topic><topic>Torticollis - genetics</topic><topic>Torticollis - therapy</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zittel, Simone</creatorcontrib><creatorcontrib>Hidding, Ute</creatorcontrib><creatorcontrib>Trumpfheller, Maria</creatorcontrib><creatorcontrib>Baltzer, Vanessa Lupici</creatorcontrib><creatorcontrib>Gulberti, Alessandro</creatorcontrib><creatorcontrib>Schaper, Miriam</creatorcontrib><creatorcontrib>Biermann, Maxine</creatorcontrib><creatorcontrib>Buhmann, Carsten</creatorcontrib><creatorcontrib>Engel, Andreas K.</creatorcontrib><creatorcontrib>Gerloff, Christian</creatorcontrib><creatorcontrib>Westphal, Manfred</creatorcontrib><creatorcontrib>Stadler, Jana</creatorcontrib><creatorcontrib>Köppen, Johannes A.</creatorcontrib><creatorcontrib>Pötter-Nerger, Monika</creatorcontrib><creatorcontrib>Moll, Christian K. E.</creatorcontrib><creatorcontrib>Hamel, Wolfgang</creatorcontrib><collection>Springer Nature OA Free Journals</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>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</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><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zittel, Simone</au><au>Hidding, Ute</au><au>Trumpfheller, Maria</au><au>Baltzer, Vanessa Lupici</au><au>Gulberti, Alessandro</au><au>Schaper, Miriam</au><au>Biermann, Maxine</au><au>Buhmann, Carsten</au><au>Engel, Andreas K.</au><au>Gerloff, Christian</au><au>Westphal, Manfred</au><au>Stadler, Jana</au><au>Köppen, Johannes A.</au><au>Pötter-Nerger, Monika</au><au>Moll, Christian K. E.</au><au>Hamel, Wolfgang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders</atitle><jtitle>Journal of neurology</jtitle><stitle>J Neurol</stitle><addtitle>J Neurol</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>267</volume><issue>6</issue><spage>1663</spage><epage>1671</epage><pages>1663-1671</pages><issn>0340-5354</issn><eissn>1432-1459</eissn><abstract>Background
Deep brain stimulation (DBS) within the pallidum represents an effective and well-established treatment for isolated dystonia. However, clinical outcome after surgery may be variable with limited response in 10–25% of patients. The effect of lead location on clinical improvement is still under debate.
Objective
To identify stimulated brain regions associated with the most beneficial clinical outcome in dystonia patients.
Methods
18 patients with cervical and generalized dystonia with chronic DBS of the internal pallidum were investigated. Patients were grouped according to their clinical improvement into responders, intermediate responders and non-responders. Magnetic resonance and computed tomography images were co-registered, and the volume of tissue activated (VTA) with respect to the pallidum of individual patients was analysed.
Results
VTAs in responders (
n
= 11), intermediate responders (
n
= 3) and non-responders (
n
= 4) intersected with the posterior internal (GPi) and external (GPe) pallidum and the subpallidal area. VTA heat maps showed an almost complete overlap of VTAs of responders, intermediate and non-responders. VTA coverage of the GPi was not higher in responders. In contrast, VTAs of intermediate and non-responders covered the GPi to a significantly larger extent in the left hemisphere (
p
< 0.01).
Conclusions
DBS of ventral parts of the posterior GPi, GPe and the adjacent subpallidal area containing pallidothalamic output projections resulted in favourable clinical effects. Of note, non-responders were also stimulated within the same area. This suggests that factors other than mere lead location (e.g., clinical phenotype, genetic background) have determined clinical outcome in the present cohort.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32067124</pmid><doi>10.1007/s00415-020-09753-z</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0340-5354 |
| ispartof | Journal of neurology, 2020-06, Vol.267 (6), p.1663-1671 |
| issn | 0340-5354 1432-1459 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7293687 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Adolescent Adult Aged Clinical outcomes Computed tomography Deep brain stimulation Deep Brain Stimulation - methods Dystonia Dystonic Disorders - diagnostic imaging Dystonic Disorders - genetics Dystonic Disorders - therapy Electrodes, Implanted Female Gene mapping Globus Pallidus - anatomy & histology Globus Pallidus - diagnostic imaging Globus Pallidus - surgery Hemispheric laterality Humans Magnetic resonance imaging Male Medicine Medicine & Public Health Middle Aged Neurology Neuroradiology Neurosciences Original Communication Outcome Assessment, Health Care Pallidum (ventral) Patients Phenotypes Retrospective Studies Surgery Torticollis - diagnostic imaging Torticollis - genetics Torticollis - therapy Young Adult |
| title | Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-26T20%3A43%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Pallidal%20lead%20placement%20in%20dystonia:%20leads%20of%20non-responders%20are%20contained%20within%20an%20anatomical%20range%20defined%20by%20responders&rft.jtitle=Journal%20of%20neurology&rft.au=Zittel,%20Simone&rft.date=2020-06-01&rft.volume=267&rft.issue=6&rft.spage=1663&rft.epage=1671&rft.pages=1663-1671&rft.issn=0340-5354&rft.eissn=1432-1459&rft_id=info:doi/10.1007/s00415-020-09753-z&rft_dat=%3Cproquest_pubme%3E2412653146%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2412653146&rft_id=info:pmid/32067124&rfr_iscdi=true |