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A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia.
J Neurosurg. 2013 Dec; 119(6):1537-45.JN

Abstract

OBJECT

The authors' aim was to compare the subthalamic nucleus (STN) with the globus pallidus internus (GPi) as a stimulation target for deep brain stimulation (DBS) for medically refractory dystonia.

METHODS

In a prospective double-blind crossover study, electrodes were bilaterally implanted in the STN and GPi of 12 patients with focal, multifocal, or generalized dystonia. Each patient was randomly selected to undergo initial bilateral stimulation of either the STN or the GPi for 6 months, followed by bilateral stimulation of the other nucleus for another 6 months. Preoperative and postoperative ratings were assessed by using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and video recordings. Quality of life was evaluated by using questionnaires (36-item Short Form Health Survey). Supplemental Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed for patients with focal dystonia (torticollis) by examining the video recordings.

RESULTS

On average for all patients, DBS improved the BFMDRS movement scores (p < 0.05) and quality of life physical scores (p < 0.01). After stimulation of the STN, the mean 6-month improvement in BFMDRS movement score was 13.8 points; after stimulation of the GPi, this improvement was 9.1 points (p = 0.08). Quality of life did not differ significantly regardless of which nucleus was stimulated. All 12 patients accepted 6 months of stimulation of the STN, but only 7 accepted 6 months of stimulation of the GPi. Among those who rejected stimulation of the GPi, 3 accepted concomitant stimulation of both the STN and GPi for 6 months, resulting in improved quality of life physical and mental scores and BFMDRS movement scores. Among the 4 patients who were rated according to TWSTRS, after 6 months of stimulation of both the STN and GPi, TWSTRS scores improved by 4.7% after stimulation of the GPi and 50.8% after stimulation of the STN (p = 0.08).

CONCLUSIONS

The STN seems to be a well-accepted, safe, and promising stimulation target in the treatment of dystonia, but further studies are necessary before the optimal target can be concluded. Simultaneous stimulation of the STN and GPi should be further investigated. Clinical trial registration no.: KF 01-110/01 (Committees on Biomedical Research Ethics of the Capital Region of Denmark).

Authors+Show Affiliations

Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital;No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

24116723

Citation

Schjerling, Lisbeth, et al. "A Randomized Double-blind Crossover Trial Comparing Subthalamic and Pallidal Deep Brain Stimulation for Dystonia." Journal of Neurosurgery, vol. 119, no. 6, 2013, pp. 1537-45.
Schjerling L, Hjermind LE, Jespersen B, et al. A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia. J Neurosurg. 2013;119(6):1537-45.
Schjerling, L., Hjermind, L. E., Jespersen, B., Madsen, F. F., Brennum, J., Jensen, S. R., Løkkegaard, A., & Karlsborg, M. (2013). A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia. Journal of Neurosurgery, 119(6), 1537-45. https://doi.org/10.3171/2013.8.JNS13844
Schjerling L, et al. A Randomized Double-blind Crossover Trial Comparing Subthalamic and Pallidal Deep Brain Stimulation for Dystonia. J Neurosurg. 2013;119(6):1537-45. PubMed PMID: 24116723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia. AU - Schjerling,Lisbeth, AU - Hjermind,Lena E, AU - Jespersen,Bo, AU - Madsen,Flemming F, AU - Brennum,Jannick, AU - Jensen,Steen R, AU - Løkkegaard,Annemette, AU - Karlsborg,Merete, Y1 - 2013/10/11/ PY - 2013/10/15/entrez PY - 2013/10/15/pubmed PY - 2014/2/25/medline SP - 1537 EP - 45 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 119 IS - 6 N2 - OBJECT: The authors' aim was to compare the subthalamic nucleus (STN) with the globus pallidus internus (GPi) as a stimulation target for deep brain stimulation (DBS) for medically refractory dystonia. METHODS: In a prospective double-blind crossover study, electrodes were bilaterally implanted in the STN and GPi of 12 patients with focal, multifocal, or generalized dystonia. Each patient was randomly selected to undergo initial bilateral stimulation of either the STN or the GPi for 6 months, followed by bilateral stimulation of the other nucleus for another 6 months. Preoperative and postoperative ratings were assessed by using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and video recordings. Quality of life was evaluated by using questionnaires (36-item Short Form Health Survey). Supplemental Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed for patients with focal dystonia (torticollis) by examining the video recordings. RESULTS: On average for all patients, DBS improved the BFMDRS movement scores (p < 0.05) and quality of life physical scores (p < 0.01). After stimulation of the STN, the mean 6-month improvement in BFMDRS movement score was 13.8 points; after stimulation of the GPi, this improvement was 9.1 points (p = 0.08). Quality of life did not differ significantly regardless of which nucleus was stimulated. All 12 patients accepted 6 months of stimulation of the STN, but only 7 accepted 6 months of stimulation of the GPi. Among those who rejected stimulation of the GPi, 3 accepted concomitant stimulation of both the STN and GPi for 6 months, resulting in improved quality of life physical and mental scores and BFMDRS movement scores. Among the 4 patients who were rated according to TWSTRS, after 6 months of stimulation of both the STN and GPi, TWSTRS scores improved by 4.7% after stimulation of the GPi and 50.8% after stimulation of the STN (p = 0.08). CONCLUSIONS: The STN seems to be a well-accepted, safe, and promising stimulation target in the treatment of dystonia, but further studies are necessary before the optimal target can be concluded. Simultaneous stimulation of the STN and GPi should be further investigated. Clinical trial registration no.: KF 01-110/01 (Committees on Biomedical Research Ethics of the Capital Region of Denmark). SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/24116723/A_randomized_double_blind_crossover_trial_comparing_subthalamic_and_pallidal_deep_brain_stimulation_for_dystonia_ L2 - https://thejns.org/doi/10.3171/2013.8.JNS13844 DB - PRIME DP - Unbound Medicine ER -