open access

Vol 45, No 3 (2011)
ARTYKUŁ ORYGINALNY
Submitted: 2010-07-03
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Chronic bilateral pallidal stimulation in patients with generalized primary dystonia – multi-contact cathodal stimulation is superior to bipolar stimulation mode. Preliminary results

Michał Sobstyl, Mirosław Ząbek, Sebastian Dzierzęcki, Henryk Koziara, Zbigniew Mossakowski
DOI: 10.1016/S0028-3843(14)60078-5
·
Neurol Neurochir Pol 2011;45(3):252-259.

open access

Vol 45, No 3 (2011)
ARTYKUŁ ORYGINALNY
Submitted: 2010-07-03

Abstract

Background and purpose

Primary generalized dystonia (PGD) is a medically refractory progressive disease of the brain causing near total handicap of affected patients. The aim of the study was to assess the efficacy and safety of bilateral pallidal stimulation in patients with PGD.

Material and methods

The study population is composed of 5 patients with PGD. The formal objective assessment included the Burke-Fahn-Marsden dystonia rating scale (BFMDRS). All stereotactic procedures were performed in general anaesthesia using a Leksell G stereotactic head frame without electrophysiological guidance. Immediately after insertion of deep brain stimulation (DBS) leads, the internal pulse generators (Itrel II or Soletra) were implanted subcutaneously in the chest wall or abdominal region.

Results

There were no complications related to the stereotactic procedures. The hardware-related complications (two broken DBS leads) were replaced successfully. There were no infections or erosions of implanted hardware. It has been observed that in the long-term follow-up period primary set bipolar stimulation mode lost its benefit achieved previously. Various stimulation combinations were investigated. Monopolar cathodal or especially multi-contact cathodal stimulation was the most effective one. The efficacy of bilateral pallidal stimulation was proved by the objective validated BFMDRS at long-term follow-up.

Conclusions

Response to DBS may improve with the number of activated cathodal contacts within the globus pallidus internus.

Abstract

Background and purpose

Primary generalized dystonia (PGD) is a medically refractory progressive disease of the brain causing near total handicap of affected patients. The aim of the study was to assess the efficacy and safety of bilateral pallidal stimulation in patients with PGD.

Material and methods

The study population is composed of 5 patients with PGD. The formal objective assessment included the Burke-Fahn-Marsden dystonia rating scale (BFMDRS). All stereotactic procedures were performed in general anaesthesia using a Leksell G stereotactic head frame without electrophysiological guidance. Immediately after insertion of deep brain stimulation (DBS) leads, the internal pulse generators (Itrel II or Soletra) were implanted subcutaneously in the chest wall or abdominal region.

Results

There were no complications related to the stereotactic procedures. The hardware-related complications (two broken DBS leads) were replaced successfully. There were no infections or erosions of implanted hardware. It has been observed that in the long-term follow-up period primary set bipolar stimulation mode lost its benefit achieved previously. Various stimulation combinations were investigated. Monopolar cathodal or especially multi-contact cathodal stimulation was the most effective one. The efficacy of bilateral pallidal stimulation was proved by the objective validated BFMDRS at long-term follow-up.

Conclusions

Response to DBS may improve with the number of activated cathodal contacts within the globus pallidus internus.

Get Citation

Keywords

generalized primary dystonia, bilateral pallidal stimulation, deep brain stimulation, neuromodulation

About this article
Title

Chronic bilateral pallidal stimulation in patients with generalized primary dystonia – multi-contact cathodal stimulation is superior to bipolar stimulation mode. Preliminary results

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 45, No 3 (2011)

Pages

252-259

DOI

10.1016/S0028-3843(14)60078-5

Bibliographic record

Neurol Neurochir Pol 2011;45(3):252-259.

Keywords

generalized primary dystonia
bilateral pallidal stimulation
deep brain stimulation
neuromodulation

Authors

Michał Sobstyl
Mirosław Ząbek
Sebastian Dzierzęcki
Henryk Koziara
Zbigniew Mossakowski

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