共查询到20条相似文献,搜索用时 15 毫秒
1.
Stephen Tisch Patricia Limousin John C Rothwell Peter Asselman Niall Quinn Marjan Jahanshahi Kailash P Bhatia Marwan Hariz 《Movement disorders》2006,21(10):1650-1655
A pathophysiological feature of dystonia is reduced inhibition at various levels of the nervous system, which may be detected in clinically unaffected body parts. Chronic deep brain stimulation (DBS) of the globus pallidus internus (GPi) has emerged as an effective treatment for primary torsion dystonia (PTD), although its mechanism of action and impact on inhibitory abnormalities in dystonia are unknown. We sought to understand the effect of GPi DBS on brainstem excitability in patients with PTD. We measured the blink reflex from orbicularis oculi in response to paired electrical stimulation of the supraorbital nerve at interstimulus intervals of 500 and 1,000 milliseconds in 10 patients with PTD before and at intervals of 1, 3, and 6 months after bilateral GPi DBS and in 10 healthy subjects. Patients were clinically evaluated using the Burke-Fahn-Marsden dystonia rating scale. We found R2 inhibition was significantly decreased in PTD patients compared with control subjects and progressively increased after GPi DBS, which correlated with clinical improvement in dystonia. We conclude that GPi DBS for PTD results in functional reorganization of the nervous system, which includes a long-term increase in brainstem inhibition. 相似文献
2.
Kazumichi Yamada Satoshi Goto Naohiro Soyama Osamu Shimoda Mareina Kudo Jun-ichi Kuratsu Nagako Murase Ryuji Kaji 《Movement disorders》2006,21(4):576-579
Stereotactic functional surgery is being explored as potential therapies for medically intractable paroxysmal dyskinesias (PxD). We report on a 59-year-old man in whom stimulation of globus pallidus internus produced immediate and sustained relief of paroxysmal non-kinesigenic dyskinesia secondary to a rotator cuff tears on the left shoulder. Our finding strongly suggests that altered function of neuronal circuits of the basal ganglia underlies the manifestation of PxD. 相似文献
3.
We report a rapid, dramatic and sustained improvement following bilateral pallidal stimulation in two patients affected by intractable generalized tardive dystonia. Both patients had a chronic psychiatric disorder and developed chronic disabling generalized dystonic symptoms persisting despite prolonged withdrawal of neuroleptics and all available symptomatic treatment. The clinical benefit in both patients persisted throughout all the follow up period of 13 and 7 months. The favorable and prolonged response in our two patients suggests that deep brain stimulation may be an effective treatment for medically refractory tardive dystonia. 相似文献
4.
Wataru Sako MD Satoshi Goto MD PhD Hideki Shimazu MD PhD Nagako Murase MD PhD Kazuhito Matsuzaki MD PhD Tetsuya Tamura MD Hideo Mure MD Yusuke Tomogane MD PhD Norio Arita MD PhD Hiroo Yoshikawa MD PhD Shinji Nagahiro MD PhD Ryuji Kaji MD PhD 《Movement disorders》2008,23(13):1929-1931
Tardive dystonia is a disabling movement disorder as a consequence of exposure to neuroleptic drugs. We followed 6 patients with medically refractory tardive dystonia treated by bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) for 21 ± 18 months. At last follow‐up, the Burke‐Fahn‐Marsden Dystonia Rating Scale (BFMDRS) motor score improved by 86% ± 14%, and the BFMDRS disability score improved by 80% ± 12%. Bilateral GPi‐DBS is a beneficial therapeutic option for the long‐term relief of tardive dystonia. © 2008 Movement Disorder Society 相似文献
5.
Christoph Schrader Thomas Peschel Michael Petermeyer Reinhard Dengler Dieter Hellwig 《Movement disorders》2004,19(5):583-585
We describe a patient with fluspirilene-induced tardive dyskinesia of the choreiform oro-facial-laryngeal type resistant to various conservative approaches for 7 years who underwent deep brain stimulation of the internal pallidal globe. We found immediate and marked suppression of her perioral involuntary movements with unilateral stimulation at 60 Hz. 相似文献
6.
Antero-ventral internal pallidum stimulation improves behavioral disorders in Lesch-Nyhan disease. 总被引:1,自引:0,他引:1
Laura Cif Brigitte Biolsi Sophie Gavarini Aude Saux Santiago Gil Robles Cornel Tancu Xavier Vasques Philippe Coubes 《Movement disorders》2007,22(14):2126-2129
The Lesch-Nyhan syndrome is an X-linked recessive disorder caused by a deficiency in hypoxanthine-guanine phosphoribosyl transferase, a purine salvage enzyme. Affected individuals exhibit a characteristic neurobehavioral disorder with delayed acquisition of motor skills, dystonia, severe self-mutilations, and aggressive behavior. Deep brain stimulation has been previously proposed for controlling isolated involuntary movements and psychiatric disorders. We applied a double bilateral simultaneous stimulation to limbic and motor internal pallidum in one patient for controlling both behavioral and movement disorders, respectively. The injurious compulsions disappeared; dystonia and dyskinesia were decreased at 28 months follow-up. 相似文献
7.
Meige syndrome and pallidal deep brain stimulation. 总被引:2,自引:0,他引:2
The cause of primary Meige syndrome is unknown, and although gender and age predilections are different from idiopathic torsion dystonia, most investigators consider Meige syndrome a variant of that disorder. Interest in the use of stereotactic brain surgery for refractory forms of dystonia is thus increasing. There is little experience with the use of deep brain stimulation (DBS) in focal dystonias, and reports of its use in Meige syndrome are very rare. We report on a case of Meige syndrome successfully treated with bilateral pallidal DBS. 相似文献
8.
Francisco Escamilla-Sevilla Adolfo Mínguez-Castellanos Ventura Arjona-Morón José María Martín-Linares Juan Carlos Sánchez-Alvarez Angel Ortega-Morenoa Teresa García-Gómez 《Movement disorders》2002,17(6):1383-1385
We present a 24-year-old man with idiopathic segmental cervical and truncal dystonia of juvenile onset. His condition improved after unilateral stimulation of the internal globus pallidus ipsilateral to the contracting sternocleidomastoid muscle. 相似文献
9.
10.
Alan Diamond Joohi Shahed Shaheda Azher Kevin Dat-Vuong Joseph Jankovic 《Movement disorders》2006,21(5):692-695
Globus pallidus deep brain stimulation (GPi-DBS) is a useful alternative in the treatment of dystonia. Patients selected for GPi-DBS were prospectively rated with the Unified Dystonia Rating Scale (UDRS). Also, "blinded" videotape assessments were performed. Eleven patients were identified. Compared with pre-DBS scores, there were improvements in mean total UDRS score (15.3%) and in the following subscores: neck (18.18%), trunk (32.9%), arm (17.9%), and leg (19.9%). One patient developed a skin infection and erosion requiring surgical debridement. GPi-DBS is a safe and effective treatment for generalized dystonia in patients who remained impaired, despite optimal medical therapy. 相似文献
11.
Uwe Walter MD Alexander Wolters MD Matthias Wittstock MD Reiner Benecke MD Henry W. Schroeder MD Jan‐Uwe Müller MD 《Movement disorders》2009,24(10):1538-1541
Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment in primary dystonia. Its success depends on the implantation accuracy of the DBS electrode into the targeted GPi. Discrepancies of up to 4 mm between the initial target, selected on preoperative MRI, and the final DBS lead location are caused mainly by caudal brain shift that occurs once the cranium is open. Nowadays, transcranial sonography (TCS) can display echogenic deep brain structures with higher image resolution compared to MRI under clinical conditions. Here, we demonstrate for the first time the use of a contemporary clinical high‐end TCS system for intraoperative monitoring of DBS electrode position. Herewith, a high‐resolution real‐time imaging of closely located microelectrodes and of the DBS lead through the intact skull is feasible. Simultaneous color‐coded sonographic imaging of arteries near the anatomical target allows further intraoperative refinement of DBS lead positioning, simultaneously preventing hemorrhages. © 2009 Movement Disorder Society 相似文献
12.
Maria G. Cersosimo MD Gabriela B. Raina MD Eduardo E. Benarroch MD Fabián Piedimonte MD Gabriela González Alemán PhD Federico E. Micheli MD 《Movement disorders》2009,24(10):1488-1493
To determine whether the immediate response to electrode implantation (micro lesion effect, MLE) in the internal segment of the globus pallidus (GPi) predicts symptom improvement with deep brain stimulation (DBS) at 6 months in patients with Parkinson's disease (PD) or generalized dystonia. Electrode implantation in the subthalamic nucleus (STN) prior to electrical stimulation has been reported to predict a beneficial effect of DBS in patients with PD, but whether this is also the case for the GPi in either PD or dystonia patients has not been established. We studied 20 patients (11 with PD and 9 with dystonia) who underwent electrode implantation in the GPi. Effects were assessed using standardized scales after 24 hours, weekly for 3 weeks prior to starting DBS, and after 6 months of DBS. 10 of 11 PD and 8 of 9 dystonia cases who benefited from electrode implantation also showed improvement in all motor and disability scores after 6 months of DBS of the GPi. One dystonia patient who did not show MLE benefited from DBS. The presence of MLE after electrode implantation in the GPi may help predict motor benefit from DBS in PD and generalized dystonia patients. © 2009 Movement Disorder Society 相似文献
13.
Kupsch A Klaffke S Kühn AA Meissner W Arnold G Schneider GH Maier-Hauff K Trottenberg T 《Journal of neurology》2003,250(10):1201-1205
Abstract.
The effect of stimulation frequency for pallidal deep
brain stimulation in five patients with either generalized or
segmental dystonia was evaluated three to twelve months
postoperatively via a randomized, double-blind paradigm. The
quality of life and the severity of dystonic symptoms improved
by approximately 60% and 43% respectively using a frequency of
130 Hz. Compared with 130 Hz a significant further clinical
improvement was observed at frequencies of 180 and 250 Hz, which
contrasted with a significant deterioration at lower frequencies
(5, 50 Hz) compared to 130 Hz. 相似文献
14.
We report the case of a patient with medically refractory primary dystonia who was treated with bilateral pallidal deep brain stimulation. Stimulation at 130 Hz or higher, by means of the more ventral contacts generated capsular side effects, which made their use impractical. Consequently, the patient was treated for 9 months at 130 to 185 Hz, by means of the more dorsal contacts, achieving modest results. By reducing the stimulation frequency to 80 Hz, we were able to activate the ventral contacts without inducing side effects. Within days, the patient experienced a dramatic improvement in function that has persisted for 1 year. A further reduction in stimulation frequency to 60 Hz resulted in a worsening of his symptoms. We conclude that chronic stimulation at frequencies of <100 Hz may be efficacious in dystonia and may enhance the tolerability of stimulation by means of contacts that are positioned posteroventrally within the internal globus pallidus, nearer the internal capsule. 相似文献
15.
Xuguang Liu Jignesh Tailor Shouyan Wang John Yianni Ralph Gregory John Stein Tipu Aziz 《Movement disorders》2004,19(3):336-340
In a patient of generalised dystonia treated with bilateral pallidal stimulation, serial surface EMGs recorded from the neck muscles during alternating head movements revealed progressive reduction in hypertonic activity and reversal of co-contraction to reciprocal contraction, which preceded clinical improvement. 相似文献
16.
目的: Meige综合征是一种特发性累及头面部的肌张力障碍,有时也会影响到颈部。脑深部电刺激(DBS)双侧苍白球内侧部(GPi)治疗肌张力障碍的报道比较多,但治疗Meige综合征的很少。方法对3例双侧GPi-DBS术后的Meige综合征患者进行随访4、6和60个月。所有患者术前术后均采用国际通用的Burke-Fahn-Marsden Dystonia Rating 量表(BFMDRS)评分,包括BFMDRS-Ⅰ(Movement 量表)和BFMDRS-Ⅱ(Disability量表)两个部分。结果3例Meige综合征患者手术后症状均有明显改善,BFMDRS第一部分和第二部分评分的改善率分别为(78±3.1)%(范围75%~83%)和100%。结论双侧GPi-DBS是治疗原发性Meige综合征的一种有效安全的手术方式。 相似文献
17.
Sandra Dehning MD Jan‐Hinnerk Mehrkens MD Norbert Müller MD PhD Kai Bötzel MD 《Movement disorders》2008,23(9):1300-1302
We report on a female patient with Tourette syndrome and a 12‐month follow‐up after chronic deep brain stimulation in the globus pallidus internus which resulted in excellent remission of motor and vocal tics. © 2008 Movement Disorder Society 相似文献
18.
Jerrold L Vitek Takao Hashimoto John Peoples Mahlon R DeLong Roy A E Bakay 《Movement disorders》2004,19(8):907-915
High frequency (>100Hz) electrical stimulation in both the external (GPe) and internal (GPi) segments of the globus pallidus was effective in improving parkinsonian motor signs. Improvement generally occurred at short latency (<5-10 seconds) in both GPe and GPi but was often (50% of the time) delayed in GPi. Dyskinetic movements were observed during stimulation within GPe and GPi but were more frequent in GPe (20% vs. 9%). These findings suggest that electrical stimulation in both GPe and GPi may ameliorate parkinsonian motor signs. The mechanisms responsible for these observations, however, may differ. The tendency for delayed responses with GPi stimulation suggests a more complex spatial-temporal profile of stimulation on the electrical activity of GPi neurons and/or its effect on network activity in pallido-thalamo-cortical circuitry. The rarity of delayed effects with GPe stimulation suggests a more direct role of synaptic inhibition or normalization of neuronal activity of GPi either directly by means of activation of striatopallidal fibers passing through GPe (direct pathway), by means of activation of GPe-->GPi or GPe-->subthalamic nucleus projections (indirect pathway) or indirectly by means of the tonic activation of adjacent fiber pathways. These data provide a rationale for the exploration of electrical stimulation in GPe in patients with medically intractable Parkinson's disease and provide a basis on which to develop further investigations into the use of chronic electrical stimulation for the treatment of Parkinson's disease and other movement disorders. 相似文献
19.
C. Blahak H.‐H. Capelle H. Baezner T. M. Kinfe M. G. Hennerici J. K. Krauss 《European journal of neurology》2011,18(6):872-875
Background and Purpose: The aim of the study was to analyse the lifetime of Soletra implantable pulse generators (IPG) in deep brain stimulation (DBS) of the globus pallidus internus (GPi) for dystonia, depending on stimulation parameters and the total electrical energy delivered (TEED) by the IPG. Methods: In a prospective series of 20 patients with GPi DBS for dystonia, we recorded IPG longevity and stimulation parameters over time. An evaluation of the TEED was performed using the previously suggested equation [(voltage2 × pulse width × frequency)/impedance] × 1 s. Results: During median follow‐up of 57 months (range 23–79 months), 64 IPGs were replaced because of battery depletion or end of life signal. We found a mean IPG longevity of 25.1 ± 10.1 (range 16–60) months, which was inversely correlated with the TEED (r = −0.72; P < 0.001). IPG longevity was not different between bipolar and monopolar stimulation (24.9 ± 10.8 vs. 25.4 ± 9.0 months, P = 0.76). Incongruously, the mean TEED applied throughout the lifetime cycle was significantly higher in patients with bipolar compared with monopolar stimulation (584 ± 213 vs. 387 ± 121 Joule; P < 0.01). Conclusions: Battery lifetime in GPi DBS for dystonia is substantially shorter compared with that reported in DBS for Parkinson’s disease, caused by a considerably higher voltage and greater pulse width and therefore a higher TEED applied during the battery lifetime cycle. The commonly used equation to calculate TEED, however, seems to be correct only for monopolar, but not bipolar stimulation. 相似文献
20.
Bilateral globus pallidus internus deep brain stimulation in tardive dyskinesia: a case report. 总被引:2,自引:0,他引:2
Hazem A Eltahawy Anthony Feinstein Farouk Khan Jean Saint-Cyr Anthony E Lang Andres M Lozano 《Movement disorders》2004,19(8):969-972
The clinical response of a 53-year-old woman with tardive dyskinesia treated with bilateral globus pallidus interna deep brain stimulation is described. At 18 months follow-up, her Burke-Fahn-Marsden Dystonia Rating Scale score fell from 52 (preoperative) to 21 (60% improvement). 相似文献