In:
Journal of Neurology, Springer Science and Business Media LLC, Vol. 267, No. 6 ( 2020-06), p. 1663-1671
Abstract:
Deep brain stimulation (DBS) within the pallidum represents an effective and well-established treatment for isolated dystonia. However, clinical outcome after surgery may be variable with limited response in 10–25% of patients. The effect of lead location on clinical improvement is still under debate. Objective To identify stimulated brain regions associated with the most beneficial clinical outcome in dystonia patients. Methods 18 patients with cervical and generalized dystonia with chronic DBS of the internal pallidum were investigated. Patients were grouped according to their clinical improvement into responders, intermediate responders and non-responders. Magnetic resonance and computed tomography images were co-registered, and the volume of tissue activated (VTA) with respect to the pallidum of individual patients was analysed. Results VTAs in responders ( n = 11), intermediate responders ( n = 3) and non-responders ( n = 4) intersected with the posterior internal (GPi) and external (GPe) pallidum and the subpallidal area. VTA heat maps showed an almost complete overlap of VTAs of responders, intermediate and non-responders. VTA coverage of the GPi was not higher in responders. In contrast, VTAs of intermediate and non-responders covered the GPi to a significantly larger extent in the left hemisphere ( p 〈 0.01). Conclusions DBS of ventral parts of the posterior GPi, GPe and the adjacent subpallidal area containing pallidothalamic output projections resulted in favourable clinical effects. Of note, non-responders were also stimulated within the same area. This suggests that factors other than mere lead location (e.g., clinical phenotype, genetic background) have determined clinical outcome in the present cohort.
Type of Medium:
Online Resource
ISSN:
0340-5354
,
1432-1459
DOI:
10.1007/s00415-020-09753-z
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2020
detail.hit.zdb_id:
1421299-7
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