Skip to main content
main-content

01.01.2016 | Clinical Article - Functional | Ausgabe 1/2016

Acta Neurochirurgica 1/2016

Different clinical course of pallidal deep brain stimulation for phasic- and tonic-type cervical dystonia

Zeitschrift:
Acta Neurochirurgica > Ausgabe 1/2016
Autoren:
Moonyoung Chung, Ryoong Huh
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00701-015-2646-7) contains supplementary material, which is available to authorized users.
Some of data of this study have been presented in 55th congress of Korean Society of Neurosurgeon at Oct. 17, 2015.

Comments

In this interesting study, the authors retrospectively review the clinical data of 30 patients affected by primary cervical dystonia who underwent globus pallidus internus (GPi) deep brain stimulation (DBS). This study provides some important information on this topic. The only significant factor affecting clinical outcomes was the dystonia type (phasic or tonic). A benefit was actually found for both types of cervical dystonia, but the clinical outcome of phasic-type cervical dystonia is more favorable. Intriguingly, a delayed benefit was found in both phasic- and tonic-type dystonia. This study has the merit of being conducted in a large and homogenous patient group and to demonstrate the persistence of benefit and even a delayed improvement in both dystonia types. Furthermore, it provides interesting considerations about the mechanisms underlying DBS neuromodulation. It has been suggested that DBS causes a “depolarization block” by high-frequency stimulation of neurons above their maximum firing rate inducing continuous depolarization and conduction block. Nevertheless, this interpretation does not appear completely satisfactory. Indeed, several stimulation-induced side effects, such as visual flushing, tetanic muscle contraction, and paresthesia, seemingly originates from neural activations rather than from neural block. Other possible explanations should therefore be considered. For instance, the effects of DBS on phasic-types dystonia could be the result of desynchronization of a pathologic low-frequency oscillatory activity of the central motor network. Furthermore, the distinctive feature of a delayed benefit of GPi DBS in dystonia patients suggests that this procedure can modulate neural plasticity in a manner that deserves further studies.
Alfredo Conti
Messina, Italy

Abstract

Background

Dystonia has been treated well using deep brain stimulation at the globus pallidus internus (GPi DBS). Dystonia can be categorized as two basic types of movement, phasic-type and tonic-type. Cervical dystonia is the most common type of focal dystonia, and sequential differences in clinical outcomes between phasic-type and tonic-type cervical dystonia have not been reported.

Methods

This study included a retrospective cohort of 30 patients with primary cervical dystonia who underwent GPi DBS. Age, disease duration, dystonia direction, movement types, employment status, relevant life events, and neuropsychological examinations were analyzed with respect to clinical outcomes following GPi DBS.

Results

The only significant factor affecting clinical outcomes was movement type (phasic or tonic). Sequential changes in clinical outcomes showed significant differences between phasic- and tonic-type cervical dystonia. A delayed benefit was found in both phasic- and tonic-type dystonia.

Conclusions

The clinical outcome of phasic-type cervical dystonia is more favorable than that of tonic-type cervical dystonia following GPi DBS.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

★ PREMIUM-INHALT
e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de. Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

Jetzt e.Med zum Sonderpreis bestellen!

Weitere Produktempfehlungen anzeigen
Zusatzmaterial
ESM 1 (DOCX 23 kb)
701_2015_2646_MOESM1_ESM.docx
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2016

Acta Neurochirurgica 1/2016 Zur Ausgabe

How I Do it - Neurosurgical Techniques

Anterior temporal lobectomy

  1. Sie können e.Med Neurologie & Psychiatrie 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.

  2. Sie können e.Med Neurologie 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.

  3. Sie können e.Med Chirurgie 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.


 

Neu im Fachgebiet Chirurgie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Chirurgie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise