Uncommon Applications of Deep Brain Stimulation in Hyperkinetic Movement Disorders

被引:14
|
作者
Smith, Kara M. [1 ]
Spindler, Meredith A. [1 ]
机构
[1] Univ Penn, Perelman Sch Med, Dept Neurol, Philadelphia, PA 19104 USA
来源
TREMOR AND OTHER HYPERKINETIC MOVEMENTS | 2015年 / 5卷
关键词
Deep brain stimulation; myoclonus-dystonia; ballism; Huntington's disease; chorea-acanthocytosis; Gilles de la Tourette syndrome; tardive dyskinesia;
D O I
10.7916/D84X56HP
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: In addition to the established indications of tremor and dystonia, deep brain stimulation (DBS) has been utilized less commonly for several hyperkinetic movement disorders, including medication-refractory myoclonus, ballism, chorea, and Gilles de la Tourette (GTS) and tardive syndromes. Given the lack of adequate controlled trials, it is difficult to translate published reports into clinical use. We summarize the literature, draw conclusions regarding efficacy when possible, and highlight concerns and areas for future study. Methods: A Pubmed search was performed for English-language articles between January 1980 and June 2014. Studies were selected if they focused primarily on DBS to treat the conditions of focus. Results: We identified 49 cases of DBS for myoclonus-dystonia, 21 for Huntington's disease, 15 for choreacanthocytosis, 129 for GTS, and 73 for tardive syndromes. Bilateral globus pallidus interna (GPi) DBS was the most frequently utilized procedure for all conditions except GTS, in which medial thalamic DBS was more common. While the majority of cases demonstrate some improvement, there are also reports of no improvement or even worsening of symptoms in each condition. The few studies including functional or quality of life outcomes suggest benefit. A limited number of studies included blinded on/off testing. There have been two double-blind controlled trials performed in GTS and a single prospective double-blind, uncontrolled trial in tardive syndromes. Patient characteristics, surgical target, stimulation parameters, and duration of follow-up varied among studies. Discussion: Despite these extensive limitations, the literature overall supports the efficacy of DBS in these conditions, in particular GTS and tardive syndromes. For other conditions, the preliminary evidence from small studies is promising and encourages further study.
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页数:17
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