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Bilateral deep brain stimulation of the globus pallidus to treat tardive dyskinesia.
Arch Gen Psychiatry. 2007 Feb; 64(2):170-6.AG

Abstract

CONTEXT

Tardive dyskinesia (TD) is a common and potentially disabling disorder induced by use of antipsychotic drugs for which medical treatment often gives disappointing results.

OBJECTIVE

To assess the efficacy of bilateral deep brain stimulation of the internal part of the globus pallidus to treat severe TD.

DESIGN

Prospective phase 2 multicenter study.

SETTING

Six French university hospitals. Patients Patients with severe TD refractory to medical treatment were studied to evaluate the severity of abnormal involuntary movements before and after 6 months of bilateral globus pallidus deep brain stimulation. A 2-step open Fleming procedure was used to avoid unnecessary accrual of patients. A successful outcome was defined as a decrease of more than 40% in the main outcome measure at 6 months. The early stopping rule was invoked if the number of successful outcomes in 10 patients was fewer than 2, or 5 or more. A double-blind evaluation in the presence and absence of stimulation was performed at 6 months after surgery. Main Outcome Measure Change in score on the Extrapyramidal Symptoms Rating Scale.

RESULTS

At 6 months after surgery, the Extrapyramidal Symptoms Rating Scale score had decreased compared with baseline by more than 40% (mean improvement, 61%; range, 44%-75%) in the first 10 patients included. In accord with the 2-step open Fleming procedure, we ended the trial at the first step and concluded that pallidal stimulation is an effective treatment for TD. The efficacy of the treatment was confirmed by a double-blind evaluation, with a mean decrease of 50% (range, 30%-66%) (P = .002) in the Extrapyramidal Symptoms Rating Scale score when stimulation was applied compared with the absence of stimulation. There were no marked changes in the patients' psychiatric status.

CONCLUSION

Although these results need to be confirmed in a larger group of patients with a longer follow-up, bilateral globus pallidus deep brain stimulation seems to offer a much-needed new treatment option for disabling TD.

Authors+Show Affiliations

Centre Hospitalier Universitaire de Nantes, Centre d'Investigation Clinique, Nantes, France. philippe.damier@chu-nantes.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17283284

Citation

Damier, Philippe, et al. "Bilateral Deep Brain Stimulation of the Globus Pallidus to Treat Tardive Dyskinesia." Archives of General Psychiatry, vol. 64, no. 2, 2007, pp. 170-6.
Damier P, Thobois S, Witjas T, et al. Bilateral deep brain stimulation of the globus pallidus to treat tardive dyskinesia. Arch Gen Psychiatry. 2007;64(2):170-6.
Damier, P., Thobois, S., Witjas, T., Cuny, E., Derost, P., Raoul, S., Mertens, P., Peragut, J. C., Lemaire, J. J., Burbaud, P., Nguyen, J. M., Llorca, P. M., & Rascol, O. (2007). Bilateral deep brain stimulation of the globus pallidus to treat tardive dyskinesia. Archives of General Psychiatry, 64(2), 170-6.
Damier P, et al. Bilateral Deep Brain Stimulation of the Globus Pallidus to Treat Tardive Dyskinesia. Arch Gen Psychiatry. 2007;64(2):170-6. PubMed PMID: 17283284.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bilateral deep brain stimulation of the globus pallidus to treat tardive dyskinesia. AU - Damier,Philippe, AU - Thobois,Stéphane, AU - Witjas,Tatiana, AU - Cuny,Emmanuel, AU - Derost,Philippe, AU - Raoul,Sylvie, AU - Mertens,Patrick, AU - Peragut,Jean-Claude, AU - Lemaire,Jean-Jacques, AU - Burbaud,Pierre, AU - Nguyen,Jean-Michel, AU - Llorca,Pierre-Michel, AU - Rascol,Olivier, AU - ,, PY - 2007/2/7/pubmed PY - 2007/4/17/medline PY - 2007/2/7/entrez SP - 170 EP - 6 JF - Archives of general psychiatry JO - Arch. Gen. Psychiatry VL - 64 IS - 2 N2 - CONTEXT: Tardive dyskinesia (TD) is a common and potentially disabling disorder induced by use of antipsychotic drugs for which medical treatment often gives disappointing results. OBJECTIVE: To assess the efficacy of bilateral deep brain stimulation of the internal part of the globus pallidus to treat severe TD. DESIGN: Prospective phase 2 multicenter study. SETTING: Six French university hospitals. Patients Patients with severe TD refractory to medical treatment were studied to evaluate the severity of abnormal involuntary movements before and after 6 months of bilateral globus pallidus deep brain stimulation. A 2-step open Fleming procedure was used to avoid unnecessary accrual of patients. A successful outcome was defined as a decrease of more than 40% in the main outcome measure at 6 months. The early stopping rule was invoked if the number of successful outcomes in 10 patients was fewer than 2, or 5 or more. A double-blind evaluation in the presence and absence of stimulation was performed at 6 months after surgery. Main Outcome Measure Change in score on the Extrapyramidal Symptoms Rating Scale. RESULTS: At 6 months after surgery, the Extrapyramidal Symptoms Rating Scale score had decreased compared with baseline by more than 40% (mean improvement, 61%; range, 44%-75%) in the first 10 patients included. In accord with the 2-step open Fleming procedure, we ended the trial at the first step and concluded that pallidal stimulation is an effective treatment for TD. The efficacy of the treatment was confirmed by a double-blind evaluation, with a mean decrease of 50% (range, 30%-66%) (P = .002) in the Extrapyramidal Symptoms Rating Scale score when stimulation was applied compared with the absence of stimulation. There were no marked changes in the patients' psychiatric status. CONCLUSION: Although these results need to be confirmed in a larger group of patients with a longer follow-up, bilateral globus pallidus deep brain stimulation seems to offer a much-needed new treatment option for disabling TD. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/17283284/Bilateral_deep_brain_stimulation_of_the_globus_pallidus_to_treat_tardive_dyskinesia_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=17283284.ui DB - PRIME DP - Unbound Medicine ER -