Tags

Type your tag names separated by a space and hit enter

Deep brain stimulation of the globus pallidus internus versus the subthalamic nucleus in isolated dystonia.
J Neurosurg. 2019 Mar 08 [Online ahead of print]JN

Abstract

OBJECTIVES

urgical procedures involving deep brain stimulation (DBS) of the globus pallidus internus (GPi) or subthalamic nucleus (STN) are well-established treatments for isolated dystonia. However, selection of the best stimulation target remains a matter of debate. The authors' objective was to compare the effectiveness of DBS of the GPi and the STN in patients with isolated dystonia.

METHODS

In this matched retrospective cohort study, the authors searched an institutional database for data on all patients with isolated dystonia who had undergone bilateral implantation of DBS electrodes in either the GPi or STN in the period from January 30, 2014, to June 30, 2017. Standardized assessments of dystonia and health-related quality of life using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and SF-36 were conducted before and at 1, 6, and 12 months after surgery. No patients were lost to the 6-month follow-up; 5 patients were lost to the 12-month follow-up.

RESULTS

Both GPi (14 patients) and STN (16 patients) stimulation produced significant improvement in dystonia and quality of life in all 30 patients found in the database search. At the 1-month follow-up, however, the percentage improvement in the BFMDRS total movement score was significantly (p = 0.01) larger after STN DBS (64%) than after GPi DBS (48%). At the 12-month follow-up, the percentage improvement in the axis subscore was significantly (p = 0.03) larger after GPi DBS (93%) than after STN DBS (83%). Also, the total amount of electrical energy delivered was significantly (p = 0.008) lower with STN DBS than with GPi DBS (124 ± 52 vs 192 ± 65 μJ, respectively).

CONCLUSIONS

The GPi and STN are both effective targets in alleviating dystonia and improving quality of life. However, GPi stimulation may be better for patients with axial symptoms. Moreover, STN stimulation may produce a larger clinical response within 1 month after surgery and may have a potential economic advantage in terms of lower battery consumption.

Authors+Show Affiliations

1Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai. 2Laboratory of Neurodegenerative Diseases and Key Laboratory of Stem Cell Biology, Institute of Health Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai; and.1Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai. 2Laboratory of Neurodegenerative Diseases and Key Laboratory of Stem Cell Biology, Institute of Health Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai; and.1Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.3Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.3Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.3Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.1Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.1Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.3Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.3Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.2Laboratory of Neurodegenerative Diseases and Key Laboratory of Stem Cell Biology, Institute of Health Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai; and.3Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30849756

Citation

Lin, Suzhen, et al. "Deep Brain Stimulation of the Globus Pallidus Internus Versus the Subthalamic Nucleus in Isolated Dystonia." Journal of Neurosurgery, 2019, pp. 1-12.
Lin S, Wu Y, Li H, et al. Deep brain stimulation of the globus pallidus internus versus the subthalamic nucleus in isolated dystonia. J Neurosurg. 2019.
Lin, S., Wu, Y., Li, H., Zhang, C., Wang, T., Pan, Y., He, L., Shen, R., Deng, Z., Sun, B., Ding, J., & Li, D. (2019). Deep brain stimulation of the globus pallidus internus versus the subthalamic nucleus in isolated dystonia. Journal of Neurosurgery, 1-12. https://doi.org/10.3171/2018.12.JNS181927
Lin S, et al. Deep Brain Stimulation of the Globus Pallidus Internus Versus the Subthalamic Nucleus in Isolated Dystonia. J Neurosurg. 2019 Mar 8;1-12. PubMed PMID: 30849756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep brain stimulation of the globus pallidus internus versus the subthalamic nucleus in isolated dystonia. AU - Lin,Suzhen, AU - Wu,Yiwen, AU - Li,Hongxia, AU - Zhang,Chencheng, AU - Wang,Tao, AU - Pan,Yixin, AU - He,Lu, AU - Shen,Ruinan, AU - Deng,Zhengdao, AU - Sun,Bomin, AU - Ding,Jianqing, AU - Li,Dianyou, Y1 - 2019/03/08/ PY - 2018/07/04/received PY - 2018/12/03/accepted PY - 2019/3/9/entrez PY - 2019/3/9/pubmed PY - 2019/3/9/medline KW - AC-PC = anterior commissure–posterior commissure KW - BFMDRS = Burke-Fahn-Marsden Dystonia Rating Scale KW - DBS = deep brain stimulation KW - GPi = globus pallidus internus KW - STN = subthalamic nucleus KW - TEED = total electrical energy delivered KW - deep brain stimulation KW - functional neurosurgery KW - globus pallidus internus KW - isolated dystonia KW - subthalamic nucleus SP - 1 EP - 12 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVESurgical procedures involving deep brain stimulation (DBS) of the globus pallidus internus (GPi) or subthalamic nucleus (STN) are well-established treatments for isolated dystonia. However, selection of the best stimulation target remains a matter of debate. The authors' objective was to compare the effectiveness of DBS of the GPi and the STN in patients with isolated dystonia.METHODSIn this matched retrospective cohort study, the authors searched an institutional database for data on all patients with isolated dystonia who had undergone bilateral implantation of DBS electrodes in either the GPi or STN in the period from January 30, 2014, to June 30, 2017. Standardized assessments of dystonia and health-related quality of life using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and SF-36 were conducted before and at 1, 6, and 12 months after surgery. No patients were lost to the 6-month follow-up; 5 patients were lost to the 12-month follow-up.RESULTSBoth GPi (14 patients) and STN (16 patients) stimulation produced significant improvement in dystonia and quality of life in all 30 patients found in the database search. At the 1-month follow-up, however, the percentage improvement in the BFMDRS total movement score was significantly (p = 0.01) larger after STN DBS (64%) than after GPi DBS (48%). At the 12-month follow-up, the percentage improvement in the axis subscore was significantly (p = 0.03) larger after GPi DBS (93%) than after STN DBS (83%). Also, the total amount of electrical energy delivered was significantly (p = 0.008) lower with STN DBS than with GPi DBS (124 ± 52 vs 192 ± 65 μJ, respectively).CONCLUSIONSThe GPi and STN are both effective targets in alleviating dystonia and improving quality of life. However, GPi stimulation may be better for patients with axial symptoms. Moreover, STN stimulation may produce a larger clinical response within 1 month after surgery and may have a potential economic advantage in terms of lower battery consumption. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/30849756/Deep_brain_stimulation_of_the_globus_pallidus_internus_versus_the_subthalamic_nucleus_in_isolated_dystonia_ L2 - https://thejns.org/doi/10.3171/2018.12.JNS181927 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.