Universität zu Köln

Pauls, K. Amande M., Krauss, Joachim K., Kaempfer, Constanze E., Kuehn, Andrea A., Schrader, Christoph, Sudmeyer, Martin, Allert, Niels, Benecke, Rainer, Blahak, Christian, Boller, Jana K., Fink, Gereon R. ORCID: 0000-0002-8230-1856, Fogel, Wolfgang, Liebig, Thomas, El Majdoub, Faycal, Mahlknecht, Philipp ORCID: 0000-0003-0671-0516, Kessler, Josef, Mueller, Joerg, Voges, Juergen, Wittstock, Matthias, Wolters, Alexander, Maarouf, Mohammad, Moro, Elena, Volkmann, Jens, Bhatia, Kailash P. and Timmermann, Lars (2017). Causes of failure of pallidal deep brain stimulation in cases with pre-operative diagnosis of isolated dystonia. Parkinsonism Relat. Disord., 43. S. 38 - 49. OXFORD: ELSEVIER SCI LTD. ISSN 1873-5126

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Abstract

Introduction: Pallidal deep brain stimulation (GPi-DBS) is an effective therapy for isolated dystonia, but 10-20% of patients show improvement below 25-30%. We here investigated causes of insufficient response to GPi-DBS in isolated dystonia in a cross-sectional study. Methods: Patients with isolated dystonia at time of surgery, and<30% improvement on the Burke-Fahn-Marsden dystonia-rating-scale (BFMDRS) after >= 6 months of continuous GPi-DBS were videotaped ON and OFF stimulation, and history, preoperative videos, brain MRI, medical records, stimulation settings, stimulation system integrity, lead location, and genetic information were obtained and reviewed by an expert panel. Results: 22 patients from 11 centres were included (8 men, 14 women; 9 generalized, 9 segmental, 3 focal, 1 bibrachial dystonia; mean (range): age 48.7 (25-72) years, disease duration 22.0 (2-40) years, DBS duration 45.5 (6-131) months). Mean BFMDRS-score was 31.7 (4-93) preoperatively and 32.3 (5-101) postoperatively. Half of the patients (n = 11) had poor lead positioning alone or in combination with other problems (combined with: other disease n = 6, functional dystonia n = 1, other problems n = 2). Other problems were disease other than isolated inherited or idiopathic dystonia (n = 5), fixed deformities (n = 2), functional dystonia (n = 3), and other causes (n = 1). Excluding patients with poor lead location from further analysis, non-isolated dystonia accounted for 45.5%, functional dystonia for 27.3%, and fixed deformities for 18.2%. In patients with true isolated dystonia, lead location was the most frequent problem. Conclusion: After exclusion of lead placement and stimulation programming issues, non-isolated dystonia, functional dystonia and fixed deformities account for the majority of GPi-DBS failures in dystonia. (c) 2017 The Authors. Published by Elsevier Ltd.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Pauls, K. Amande M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Krauss, Joachim K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kaempfer, Constanze E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuehn, Andrea A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schrader, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Sudmeyer, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Allert, Niels UNSPECIFIED UNSPECIFIED UNSPECIFIED Benecke, Rainer UNSPECIFIED UNSPECIFIED UNSPECIFIED Blahak, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Boller, Jana K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fink, Gereon R. UNSPECIFIED orcid.org/0000-0002-8230-1856 UNSPECIFIED Fogel, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Liebig, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED El Majdoub, Faycal UNSPECIFIED UNSPECIFIED UNSPECIFIED Mahlknecht, Philipp UNSPECIFIED orcid.org/0000-0003-0671-0516 UNSPECIFIED Kessler, Josef UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Voges, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittstock, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Wolters, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Maarouf, Mohammad UNSPECIFIED UNSPECIFIED UNSPECIFIED Moro, Elena UNSPECIFIED UNSPECIFIED UNSPECIFIED Volkmann, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Bhatia, Kailash P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Timmermann, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-216947
DOI:	10.1016/j.parkreldis.2017.06.023
Journal or Publication Title:	Parkinsonism Relat. Disord.
Volume:	43
Page Range:	S. 38 - 49
Date:	2017
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1873-5126
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PRIMARY GENERALIZED DYSTONIA; DYSKINETIC CEREBRAL-PALSY; CERVICAL DYSTONIA; SEGMENTAL DYSTONIA; MOVEMENT-DISORDERS; CLINICAL-EFFICACY; DISEASE DURATION; GLOBUS-PALLIDUS; DYT1 DYSTONIA; RATING-SCALE Multiple languages Clinical Neurology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21694