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. 2007 Dec;78(12):1314-9.
doi: 10.1136/jnnp.2006.109694. Epub 2007 Apr 18.

Effect of electrode contact location on clinical efficacy of pallidal deep brain stimulation in primary generalised dystonia

S Tisch  1 , L Zrinzo, P Limousin, K P Bhatia, N Quinn, K Ashkan, M Hariz
Affiliations

Effect of electrode contact location on clinical efficacy of pallidal deep brain stimulation in primary generalised dystonia

S Tisch et al. J Neurol Neurosurg Psychiatry. 2007 Dec.

Abstract

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.

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Conflict of interest statement

Competing interests: None.

References

    1. Fahn S, Bressman S B, Marsden C D. Classification of dystonia. Adv Neurol 1998781–10. - PubMed
    1. Cooper I S, Hoen T I, Poloukhine N. Chemopallidectomy for dystonia musculorum deformans. J Am Geriatr Soc 195641208–1213. - PubMed
    1. Coubes P, Echenne B, Roubertie A.et al Treatment of early‐onset generalized dystonia by chronic bilateral stimulation of the internal globus pallidus. Apropos of a case. Neurochirurgie 199945139–144. - PubMed
    1. Coubes P, Cif L, El Fertit H.et al Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long‐term results. J Neurosurg 2004101189–194. - PubMed
    1. Vidailhet M, Vercueil L, Houeto J L.et al French Stimulation du Pallidum Interne dans la Dystonie (SPIDY) Study Group. Bilateral deep‐brain stimulation of the globus pallidus in primary generalized dystonia. N Engl J Med 2005352459–467. - PubMed

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