Thomas Schönecker1, Doreen Gruber2, Anatol Kivi3, Bianca Müller3, Elmar Lobsien4, Gerd-Helge Schneider5, Andrea A Kühn6, Karl-Titus Hoffmann7, Andreas R Kupsch8. 1. Department of Neurology, Charité, University Medicine Berlin, Germany Klinikum Bremeraven, Germany. 2. Department of Neurology, Charité, University Medicine Berlin, Germany Movement Disorder Clinic Beelitz Heilstätten, Germany. 3. Department of Neurology, Charité, University Medicine Berlin, Germany Department of Neurology, Vivantes Clinic Berlin Spandau, Germany. 4. Department of Neurology, Charité, University Medicine Berlin, Germany Department of Neurology, Helios Clinic, Erfurt, Germany. 5. Department of Neurosurgery, Charité, University Medicine, Berlin, Germany. 6. Department of Neurology, Charité, University Medicine Berlin, Germany. 7. Department of Neuroradiology, University of Leipzig, Germany Department of Neuroradiology, Charité, University Medicine, Berlin, Germany. 8. Department of Neurology, Charité, University Medicine Berlin, Germany Departments of Neurology and Stereotactic Neurosurgery, Magdeburg, Germany.
Abstract
INTRODUCTION: Pallidal deep brain stimulation (DBS) has been shown to be effective in cervical dystonia (CD) with an improvement of about 50-60% in the Toronto Western Spasmodic Torticollis Rating (TWSTR) Scale. However, predictive factors for the efficacy of DBS in CD are missing with the anatomical location of the electrodes being one of the most important potential predictive factors. METHODS: In the present blinded observational study we correlated the anatomical localisation of DBS contacts with the relative clinical improvement (CI %) in the TWSTR as achieved by DBS at different pallidal contacts in 20 patients with CD. Localisations of DBS contacts were derived from postoperative MRI-data following anatomical normalisation into the standard Montreal Neurological Institute stereotactic space. The CIs following 76 bilateral test stimulations of 24 h were mapped to stereotactic coordinates of the corresponding bilateral 152 active contacts and were allocated to low CI (<30%; n=74), intermediate CI (≥30%; <60%; n=52) or high CI (≥60%; n=26). RESULTS: Euclidean distances between contacts and the centroid differed between the three clusters (p<0.001) indicating different anatomical variances between clusters. The Euclidean distances between contacts and the centroid of the cluster with high CIs correlated with the individual level of CIs (r=-0.61; p<0.0001). This relationship was best fitted with an exponential regression curve (r(2)=0.41). DISCUSSION: Our data show that the clinical effect of pallidal DBS on CD displays an exponential decay over anatomical distance from an optimised target localisation within a subregion of the internal pallidum. The results will allow a comparison of future DBS studies with postoperative MRI by verifying optimised (for instance pallidal) targeting in DBS-treated patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
INTRODUCTION: Pallidal deep brain stimulation (DBS) has been shown to be effective in cervical dystonia (CD) with an improvement of about 50-60% in the Toronto Western Spasmodic Torticollis Rating (TWSTR) Scale. However, predictive factors for the efficacy of DBS in CD are missing with the anatomical location of the electrodes being one of the most important potential predictive factors. METHODS: In the present blinded observational study we correlated the anatomical localisation of DBS contacts with the relative clinical improvement (CI %) in the TWSTR as achieved by DBS at different pallidal contacts in 20 patients with CD. Localisations of DBS contacts were derived from postoperative MRI-data following anatomical normalisation into the standard Montreal Neurological Institute stereotactic space. The CIs following 76 bilateral test stimulations of 24 h were mapped to stereotactic coordinates of the corresponding bilateral 152 active contacts and were allocated to low CI (<30%; n=74), intermediate CI (≥30%; <60%; n=52) or high CI (≥60%; n=26). RESULTS: Euclidean distances between contacts and the centroid differed between the three clusters (p<0.001) indicating different anatomical variances between clusters. The Euclidean distances between contacts and the centroid of the cluster with high CIs correlated with the individual level of CIs (r=-0.61; p<0.0001). This relationship was best fitted with an exponential regression curve (r(2)=0.41). DISCUSSION: Our data show that the clinical effect of pallidal DBS on CD displays an exponential decay over anatomical distance from an optimised target localisation within a subregion of the internal pallidum. The results will allow a comparison of future DBS studies with postoperative MRI by verifying optimised (for instance pallidal) targeting in DBS-treated patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
DYSTONIA; ELECTRICAL STIMULATION; MOVEMENT DISORDERS; MRI; NEUROANATOMY
Authors: Andrea A Kühn; R Mark Richardson; Wolf-Julian Neumann; Robert S Turner; Benjamin Blankertz; Tom Mitchell Journal: Neurotherapeutics Date: 2019-01 Impact factor: 7.620
Authors: Frank Steigerwald; Anna Dalal Kirsch; Andrea A Kühn; Andreas Kupsch; Joerg Mueller; Wilhelm Eisner; Günther Deuschl; Daniela Falk; Alfons Schnitzler; Inger Marie Skogseid; Juliane Vollmer-Haase; Chi W Ip; Volker Tronnier; Jan Vesper; Markus Naumann; Jens Volkmann Journal: Neurol Res Pract Date: 2019-09-24
Authors: Joachim K Krauss; Nir Lipsman; Tipu Aziz; Alexandre Boutet; Peter Brown; Jin Woo Chang; Benjamin Davidson; Warren M Grill; Marwan I Hariz; Andreas Horn; Michael Schulder; Antonios Mammis; Peter A Tass; Jens Volkmann; Andres M Lozano Journal: Nat Rev Neurol Date: 2020-11-26 Impact factor: 42.937
Authors: Ashley L B Raghu; John Eraifej; Nagaraja Sarangmat; John Stein; James J FitzGerald; Stephen Payne; Tipu Z Aziz; Alexander L Green Journal: Brain Date: 2021-12-31 Impact factor: 13.501