Marina Svetel1,2, Aleksandra Tomić1,2, Nataša Dragašević1,2, Igor Petrović1,2, Nikola Kresojević1, Robert Jech3, Dušan Urgošik4, Isidora Banjac2, Jelena Vitković2, Ivana Novaković5, Vladimir S Kostić6,7. 1. Clinic of Neurology, Clinical Center of Serbia, Dr. Subotica 6, Belgrade, Serbia. 2. School of Medicine, University of Belgrade, Dr. Subotića starijeg 6, 11000, Belgrade, Serbia. 3. Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic. 4. Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic. 5. Institute for Human Genetics, School of Medicine, University of Belgrade, Belgrade, Serbia. 6. Clinic of Neurology, Clinical Center of Serbia, Dr. Subotica 6, Belgrade, Serbia. vladimir.s.kostic@gmail.com. 7. School of Medicine, University of Belgrade, Dr. Subotića starijeg 6, 11000, Belgrade, Serbia. vladimir.s.kostic@gmail.com.
Abstract
INTRODUCTION: Pantothenate kinase-associated neurodegeneration (PKAN) is a rare autosomal recessive disorder with a progressive clinical course. In addition to symptomatic therapy, DBS has been increasingly recognized as a potential therapeutic strategy, especially in severe cases. Therefore, we wanted to report our experience regarding benefits of DBS in five PKAN cases in 3-year follow-up study. METHODS: Five genetically confirmed PKAN patients from Serbia underwent GPi-DBS. To assess clinical outcome, we reviewed medical charts and applied: Schwab and England Activities of Daily Living Scale (S&E), EQ-5D questionnaire for quality of life, Patient Global Impression of Improvement (GPI-I), Functional Independence Measure (FIM), Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Barry Albright Dystonia Scale (BAD). Patients were evaluated in five visits: at the disease onset, 5 years after the onset, before surgery, 6 months and 14-36 months after the surgery. Improvement of 20% was accepted as significant. RESULTS: Overall, dystonia significantly improved after GPi-DBS at 6 and 14-36 months postoperatively, when assessed by the BFMDRS and BAD. However, two patients failed to improve considerably. Four patients reported improvement on GPI-I, while one remained unchanged. Three patients reported significant improvement, when assessed with S&E and FIM. EQ-5D showed the most prominent improvement in the domains of mobility and pain/discomfort. CONCLUSION: Three out of our five patients experienced beneficial effects of the GPi-DBS, in up to 36 months follow-up. Two patients who had not reached significant improvement had longer disease duration; therefore, it might be reasonable to recommend GPi-DBS as soon as dystonia became disabling.
INTRODUCTION:Pantothenate kinase-associated neurodegeneration (PKAN) is a rare autosomal recessive disorder with a progressive clinical course. In addition to symptomatic therapy, DBS has been increasingly recognized as a potential therapeutic strategy, especially in severe cases. Therefore, we wanted to report our experience regarding benefits of DBS in five PKAN cases in 3-year follow-up study. METHODS: Five genetically confirmed PKANpatients from Serbia underwent GPi-DBS. To assess clinical outcome, we reviewed medical charts and applied: Schwab and England Activities of Daily Living Scale (S&E), EQ-5D questionnaire for quality of life, Patient Global Impression of Improvement (GPI-I), Functional Independence Measure (FIM), Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Barry Albright Dystonia Scale (BAD). Patients were evaluated in five visits: at the disease onset, 5 years after the onset, before surgery, 6 months and 14-36 months after the surgery. Improvement of 20% was accepted as significant. RESULTS: Overall, dystonia significantly improved after GPi-DBS at 6 and 14-36 months postoperatively, when assessed by the BFMDRS and BAD. However, two patients failed to improve considerably. Four patients reported improvement on GPI-I, while one remained unchanged. Three patients reported significant improvement, when assessed with S&E and FIM. EQ-5D showed the most prominent improvement in the domains of mobility and pain/discomfort. CONCLUSION: Three out of our five patients experienced beneficial effects of the GPi-DBS, in up to 36 months follow-up. Two patients who had not reached significant improvement had longer disease duration; therefore, it might be reasonable to recommend GPi-DBS as soon as dystonia became disabling.
Authors: B C Lim; C-S Ki; A Cho; H Hwang; K J Kim; Y S Hwang; Y E Kim; J Y Yun; B S Jeon; Y H Lim; S H Paek; J H Chae Journal: Eur J Neurol Date: 2011-11-22 Impact factor: 6.089
Authors: Philippe De Vloo; Darrin J Lee; Robert F Dallapiazza; Mohammad Rohani; Alfonso Fasano; Renato P Munhoz; George M Ibrahim; Mojgan Hodaie; Andres M Lozano; Suneil K Kalia Journal: Mov Disord Date: 2019-01-11 Impact factor: 10.338