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Stereotact Funct Neurosurg 2009;87:37–44

Induction of Bradykinesia with Pallidal Deep Brain Stimulation in Patients with Cranial-Cervical Dystonia

Berman B.D.a · Starr P.A.b, c · Marks, Jr. W.J.a, c · Ostrem J.L.a, c
Departments of aNeurology and bNeurological Surgery, University of California, and cDepartment of Veterans Affairs Parkinson’s Disease Research, Education, and Clinical Center (PADRECC), San Francisco, Calif., USA
email Corresponding Author

 goto top of outline Key Words

  • Dystonia
  • Deep brain stimulation
  • Globus pallidus
  • Cranial-cervical dystonia
  • Bradykinesia

 goto top of outline Abstract

Background: Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective and well-tolerated treatment for idiopathic generalized dystonia. More recently, it has been applied as a treatment for focal and segmental dystonias. This patient population offers an opportunity to study the effects of alteration of pallidal outflow on previously normal limb function. Methods: We sought to retrospectively characterize the extent of novel GPi DBS-induced adverse motor effects in patients with adult-onset cervical and cranial-cervical dystonia using a questionnaire, and compared the findings to dystonia improvement as measured by standard scales. Results: Despite significant improvement in dystonia (65% in mean Burke-Fahn-MarsdenDystonia Rating Scale motor score, p < 0.005, and 59% in mean Toronto Western Spasmodic Torticollis Rating Scale score, p < 0.008), slowing and difficulty with normal motor function was reported in previously nondystonic extremities in 10 of 11 patients. Symptoms were common in both upper and lower extremities and included new difficulties with handwriting (82%), getting up from a chair or in/out of a car (73%), and walking (45%), and were not associated with aberrant lead placement near the internal capsule. Conclusion: Although GPi DBS was shown to be effective in these patients, the influence of GPi DBS on nondystonic body regions deserves further investigation.

Copyright © 2009 S. Karger AG, Basel

 goto top of outline References
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 goto top of outline Author Contacts

Jill L. Ostrem
University of California San Francisco
400 Parnassus Ave, Box 0138
San Francisco, CA 94143 (USA)
Tel. +1 415 502 3576, Fax +1 415 502 4276, E-Mail

 goto top of outline Article Information

Published online: January 28, 2009
Number of Print Pages : 8
Number of Figures : 3, Number of Tables : 3, Number of References : 27

 goto top of outline Publication Details

Stereotactic and Functional Neurosurgery

Vol. 87, No. 1, Year 2009 (Cover Date: February 2009)

Journal Editor: Roberts D.W. (Lebanon, N.H.)
ISSN: 1011-6125 (Print), eISSN: 1423-0372 (Online)

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