Evaluation of a programming algorithm for deep brain stimulation in dystonia used in a double-blind, sham-controlled mul
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(2019) 1:25
Neurological Research and Practice
RESEARCH ARTICLE
Open Access
Evaluation of a programming algorithm for deep brain stimulation in dystonia used in a double-blind, sham-controlled multicenter study Frank Steigerwald1,2,8*† , Anna Dalal Kirsch1†, Andrea A. Kühn3, Andreas Kupsch4, Joerg Mueller5,6, Wilhelm Eisner7, Günther Deuschl8, Daniela Falk9, Alfons Schnitzler10, Inger Marie Skogseid11, Juliane Vollmer-Haase12, Chi W. Ip1, Volker Tronnier13, Jan Vesper14,15, Markus Naumann1,16, Jens Volkmann1,8 and for the DBS study group for dystonia
Abstract Background: Programming deep brain stimulation in dystonia is difficult because of the delayed benefits and absence of evidence-based guidelines. Therefore, we evaluated the efficacy of a programming algorithm applied in a double-blind, sham-controlled multicenter study of pallidal deep brain stimulation in dystonia. Methods: A standardized monopolar review to identify the contact with the best acute antidystonic effect was applied in 40 patients, who were then programmed 0.5 V below the adverse effect threshold and maintained on these settings for at least 3 months, if tolerated. If no acute effects were observed, contact selection was based on adverse effects or anatomical criteria. Three-year follow-up data was available for 31 patients, and five-year data for 32 patients. The efficacy of the algorithm was based on changes in motor scores, adverse events, and the need for reprogramming. Results: The mean (±standard deviation) dystonia motor score decreased by 73 ± 24% at 3 years and 63 ± 38% at 5 years for contacts that exhibited acute improvement of dystonia (n = 17) during the monopolar review. Contacts without acute benefit improved by 58 ± 30% at 3 years (n = 63) and 53 ± 31% at 5 years (n = 59). Interestingly, acute worsening or induction of dystonia/dyskinesia (n = 9) correlated significantly with improvement after 3 years, but not 5 years. Conclusions: Monopolar review helped to detect the best therapeutic contact in approximately 30% of patients exhibiting acute modulation of dystonic symptoms. Acute improvement, as well as worsening of dystonia, predicted a good long-term outcome, while induction of phosphenes did not correlate with outcome. Trial registration: ClinicalTrials.gov NCT00142259. Keywords: Deep brain stimulation, Programming algorithm, Dystonia, Pallidum, Long-term outcome
Background Primary dystonia comprises a heterogeneous group of incurable, idiopathic movement disorders with involuntary muscle contractions leading to twisting, repetitive * Correspondence: [email protected] † Frank Steigerwald and Anna Dalal Kirsch contributed equally to this work. 1 Department of Neurology, University Hospital Würzburg, Würzburg, Germany 2 Department of Neurology and Neurological Critical Care, Rhön-Klinikum, Bad Neustadt, Germany Full list of author information is available at the end of the article
movements and abnormal postures [1, 6]. Oral drug therapy, using combinations of antidopaminergic, anticholinergic, and muscle-r
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