Setting realistic expectations for DBS in dystonia
2012; Elsevier BV; Volume: 11; Issue: 12 Linguagem: Inglês
10.1016/s1474-4422(12)70263-6
ISSN1474-4465
AutoresMichael S. Okun, Kelly D. Foote,
Tópico(s)Botulinum Toxin and Related Neurological Disorders
ResumoThe modern era of deep brain stimulation (DBS) began in 1987, after Alim Louis Benabid's report on the successful implantation of an electrical lead in the ventral intermediate thalamus to provide chronic stimulation for the suppression of medication-refractory tremor. 1 Benabid AL Koudsie A Benazzouz A et al. Deep brain stimulation of the corpus luysi (subthalamic nucleus) and other targets in Parkinson's disease. Extension to new indications such as dystonia and epilepsy. J Neurol. 2001; 248: III37-III47 Crossref PubMed Google Scholar , 2 Benabid AL Pollak P Louveau A Henry S de Rougemont J Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987; 50: 344-346 PubMed Google Scholar Since then, DBS has been used as an effective treatment for various symptoms occurring across many disease states. 3 Benabid AL What the future holds for deep brain stimulation. Expert Rev Med Devices. 2007; 4: 895-903 Crossref PubMed Scopus (96) Google Scholar One example of the success of this therapy has been the use of DBS to treat refractory dystonia, a debilitating disease that can affect children as well as adults and can result in twisted and contorted body postures. 4 Volkmann J Herzog J Kopper F Deuschl G Introduction to the programming of deep brain stimulators. Mov Disord. 2002; 17: S181-S187 Crossref PubMed Scopus (279) Google Scholar Early results in patients with dystonia were extremely positive. One study of 23 patients reported that the Burke–Fahn–Marsden dystonia rating scale (BFMDRS) scores improved by 79·6% at 1 year, and 82·5% at 2 years postoperatively. 5 Isaias IU Volkmann J Kupsch A et al. Factors predicting protracted improvement after pallidal DBS for primary dystonia: the role of age and disease duration. J Neurol. 2011; 258: 1469-1476 Crossref PubMed Scopus (77) Google Scholar Similarly, in a 44-patient study drawn from five experienced DBS centres, BFMDRS benefits were reported as 74·9% at 1 year and 82·6% at 3 years. 6 Isaias IU Alterman RL Tagliati M Deep brain stimulation for primary generalized dystonia: long-term outcomes. Arch Neurol. 2009; 66: 465-470 Crossref PubMed Scopus (159) Google Scholar Pallidal deep brain stimulation in patients with primary generalised or segmental dystonia: 5-year follow-up of a randomised trial3 years and 5 years after surgery, pallidal neurostimulation continues to be an effective and relatively safe treatment option for patients with severe idiopathic dystonia. This long-term observation provides further evidence in favour of pallidal neurostimulation as a first-line treatment for patients with medically intractable, segmental, or generalised dystonia. Full-Text PDF
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