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Table of Contents
Vol. 91, No. 3, 2013
Issue release date: May 2013
Section title: Case Report
Stereotact Funct Neurosurg 2013;91:190-197
(DOI:10.1159/000345113)

Pallidal Deep Brain Stimulation for a Case of Hemidystonia Secondary to a Striatal Stroke

Fuller J.a · Prescott I.A.b · Moro E.c · Toda H.e · Lozano A.d · Hutchison W.D.b, d
aFaculty of Medicine and bDepartment of Physiology, University of Toronto, and Divisions of cNeurology and dNeurosurgery, Toronto Western Hospital, Toronto, Ont., Canada; eDepartment of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan

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Article / Publication Details

First-Page Preview
Abstract of Case Report

Received: August 04, 2011
Accepted: September 28, 2012
Published online: February 27, 2013
Issue release date: May 2013

Number of Print Pages: 8
Number of Figures: 4
Number of Tables: 0

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: http://www.karger.com/SFN

Abstract

Background: The efficacy of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) for medically refractory idiopathic generalized dystonia has been demonstrated repeatedly. More variable outcomes have been reported in the treatment of secondary dystonia with GPi DBS. Objectives: The present study seeks to examine the pallidal physiology and clinical outcome of GPi DBS in a case of secondary dystonia. Methods: We report on a 43-year-old man who at the age of 9 suffered a left basal ganglia stroke and at the age of 21 developed severe disabling hemidystonia. Following unsuccessful medical management for many years and an axial involvement of the dystonia, he underwent bilateral GPi DBS with dual microelectrode mapping of cell firing and evoked field potentials (fEP). Results: On the intact side we found regular firing of pallidal neurons and normal fEP indicative of functioning striatopallidal pathways. The affected side was found to include a higher frequency of bursting pallidal neurons. fEP could not be evoked on the affected side, suggesting their origin to be striatal GABAergic afferents. Conclusions: The patient had marked benefit from bilateral GPi DBS, which suggests that the therapeutic effects of DBS were mediated by the intact pathways in this case of hemidystonia.

© 2013 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Case Report

Received: August 04, 2011
Accepted: September 28, 2012
Published online: February 27, 2013
Issue release date: May 2013

Number of Print Pages: 8
Number of Figures: 4
Number of Tables: 0

ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)

For additional information: http://www.karger.com/SFN


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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