Wassilios G Meissner1, Chloé Laurencin2, Christine Tranchant3, Tatiana Witjas4, François Viallet5, Dominique Guehl6, Philippe Damier7, Jean-Luc Houeto8, François Tison1, Alexandre Eusebio4, Anne Vital9, Nathalie Streichenberger10, Béatrice Lannes11, André Maues de Paula12, Stéphane Thobois13. 1. Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; Centre de référence atrophie multisystématisée, CHU de Bordeaux, F-33076 Bordeaux, France. 2. Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Expert Parkinson's Disease Center, 69000 Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, 69000 Lyon, France; CNRS, Centre de Neurosciences Cognitives, UMR5229, Bron, France. 3. Service de Neurologie et FMTS, CHU Strasbourg, France. 4. APHM, CHU Timone, Department of Neurology and Movement Disorders, and Institut de Neurosciences de La Timone UMR 7289, Aix Marseille Université, CNRS, 13385, Marseille, France. 5. Service de Neurologie, CH intercommunal d'Aix-Pertuis, Laboratoire Parole et Langage UMR 7309 CNRS et université Aix-Marseille, 13616 Aix en Provence, France. 6. Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; Department of Clinical Neurophysiology, University Hospital Bordeaux, France. 7. Centre d'Investigation Clinique, Department of Neurology, CHU, INSERM, Nantes, France. 8. Service de Neurologie, CIC- INSERM 1402, CHU de Poitiers, Poitiers, France. 9. Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; Department of Pathology, CHU, Bordeaux, France. 10. Hospices Civils de Lyon, Groupement Hospitalier Est, Centre de Pathologie et Neuropathologie Est, service de neuropathologie, Université Claude Bernard Lyon1, CNRS UMR5239, LBMC, ENS, 69000, Lyon, France. 11. Department of Pathology, CHU, Strasbourg, France. 12. Department of Pathology, CHU, Marseille, France. 13. Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Expert Parkinson's Disease Center, 69000 Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, 69000 Lyon, France; CNRS, Centre de Neurosciences Cognitives, UMR5229, Bron, France. Electronic address: stephane.thobois@chu-lyon.fr.
Abstract
OBJECTIVES: To highlight the risk of clinical worsening after deep brain stimulation in histologically proven multiple system atrophy (MSA) patients presenting slow and relatively benign disease progression mimicking Parkinson's disease (PD). In such cases but also in more typical MSA patients, the results of deep brain stimulation have been mostly reported as case reports and small patient series. METHODS: The present study describes the outcome of the largest series of histologically proven MSA patients who underwent deep brain stimulation (DBS) of the subthalamic nucleus because they were considered as having PD at the time of surgery. RESULTS: Three patients showed significant improvement of motor signs after surgery while two did not. Clinical improvement was short-lasting and rapidly followed by the occurrence of disabling manifestations of MSA that counteracted DBS benefits. CONCLUSIONS: Together with previous reports, our study demonstrates that DBS should not be recommended for MSA patients. It also underlines that detecting subtle red flags is crucial to avoid DBS surgery in this population.
OBJECTIVES: To highlight the risk of clinical worsening after deep brain stimulation in histologically proven multiple system atrophy (MSA) patients presenting slow and relatively benign disease progression mimicking Parkinson's disease (PD). In such cases but also in more typical MSA patients, the results of deep brain stimulation have been mostly reported as case reports and small patient series. METHODS: The present study describes the outcome of the largest series of histologically proven MSA patients who underwent deep brain stimulation (DBS) of the subthalamic nucleus because they were considered as having PD at the time of surgery. RESULTS: Three patients showed significant improvement of motor signs after surgery while two did not. Clinical improvement was short-lasting and rapidly followed by the occurrence of disabling manifestations of MSA that counteracted DBS benefits. CONCLUSIONS: Together with previous reports, our study demonstrates that DBS should not be recommended for MSA patients. It also underlines that detecting subtle red flags is crucial to avoid DBS surgery in this population.
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