Hélène Pouclet-Courtemanche1, Tiphaine Rouaud1, Stephane Thobois1, Jean-Michel Nguyen1, Christine Brefel-Courbon1, Isabelle Chereau1, Emmanuel Cuny1, Philippe Derost1, Alexandre Eusebio1, Dominique Guehl1, Chloé Laurencin1, Patrick Mertens1, Fabienne Ory-Magne1, Sylvie Raoul1, Jean Regis1, Miguel Ulla1, Tatiana Witjas1, Pierre Burbaud1, Olivier Rascol1, Philippe Damier2. 1. From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France. 2. From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France. philippe.damier@chu-nantes.fr.
Abstract
OBJECTIVE: To confirm the efficacy and safety of deep brain stimulation (DBS) of the internal part of the globus pallidus in improving severe tardive dyskinesia (TD). METHODS:Nineteen patients with severe pharmacoresistant TD were included. All were assessed at baseline and at 3, 6 (main outcome measure), and 12 months, and in the long term (6-11 years) for 14 patients, after bilateral pallidal DBS, using motor scales (Extrapyramidal Symptoms Rating Scale [ESRS], Abnormal Involuntary Movement Scale [AIMS]), cognitive scales, and a psychiatric assessment. At 6 months, a double-blind ESRS evaluation was performed in the stimulation "on" and stimulation "off" conditions. RESULTS: At 6 months, all patients had a decrease of more than 40% on the ESRS. The efficacy of the procedure was confirmed by a double-blind evaluation. This improvement was maintained at 12 months (ESRS: decrease of 58% [21%-81%]; AIMS: decrease of 50% [7%-77%]) and in the long term (ESRS: decrease of 60% [22%-90%]; AIMS: decrease of 63% [14%-94%], n = 14). All the subscores of the ESRS (parkinsonism, dystonia, and chorea) and of the AIMS (facial, oral, extremities, and trunk movements) improved. Despite psychiatric comorbidities at baseline, cognitive and psychiatric tolerability of the procedure was excellent. No cognitive decline was observed and mood was improved in most of the patients. CONCLUSIONS: Pallidal DBS procedure should be considered as a therapeutic option in disabling TD refractory to medical treatment. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with severe pharmacoresistant TD with implanted pallidal leads, the stimulation "on" condition significantly improved ESRS scores compared to the stimulation "off" condition.
RCT Entities:
OBJECTIVE: To confirm the efficacy and safety of deep brain stimulation (DBS) of the internal part of the globus pallidus in improving severe tardive dyskinesia (TD). METHODS: Nineteen patients with severe pharmacoresistant TD were included. All were assessed at baseline and at 3, 6 (main outcome measure), and 12 months, and in the long term (6-11 years) for 14 patients, after bilateral pallidal DBS, using motor scales (Extrapyramidal Symptoms Rating Scale [ESRS], Abnormal Involuntary Movement Scale [AIMS]), cognitive scales, and a psychiatric assessment. At 6 months, a double-blind ESRS evaluation was performed in the stimulation "on" and stimulation "off" conditions. RESULTS: At 6 months, all patients had a decrease of more than 40% on the ESRS. The efficacy of the procedure was confirmed by a double-blind evaluation. This improvement was maintained at 12 months (ESRS: decrease of 58% [21%-81%]; AIMS: decrease of 50% [7%-77%]) and in the long term (ESRS: decrease of 60% [22%-90%]; AIMS: decrease of 63% [14%-94%], n = 14). All the subscores of the ESRS (parkinsonism, dystonia, and chorea) and of the AIMS (facial, oral, extremities, and trunk movements) improved. Despite psychiatric comorbidities at baseline, cognitive and psychiatric tolerability of the procedure was excellent. No cognitive decline was observed and mood was improved in most of the patients. CONCLUSIONS: Pallidal DBS procedure should be considered as a therapeutic option in disabling TD refractory to medical treatment. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with severe pharmacoresistant TD with implanted pallidal leads, the stimulation "on" condition significantly improved ESRS scores compared to the stimulation "off" condition.
Authors: Eman M Khedr; Bastawy Al Fawal; Ahmed Abdelwarith; Mostafa Saber; John C Rothwell Journal: J Neural Transm (Vienna) Date: 2018-10-13 Impact factor: 3.575