Deep brain stimulation for dystonia
| Autor: | Thomas J. Loher, Joachim K. Krauss, Tipu Z. Aziz, John Yianni |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
congenital
hereditary and neonatal diseases and abnormalities Movement disorders Deep brain stimulation Physiology medicine.medical_treatment Stimulation Electric Stimulation Therapy Local field potential Functional neurosurgery Globus Pallidus Thalamus Physiology (medical) otorhinolaryngologic diseases Medicine Humans Cervical dystonia Thalamic stimulator Dystonia Brain Mapping business.industry Electroencephalography medicine.disease nervous system diseases Treatment Outcome Neurology Neurology (clinical) medicine.symptom business Neuroscience Microelectrodes |
| Popis: | Within the past few years, there has been a renaissance of functional neurosurgery for the treatment of dystonic movement disorders. In particular, deep brain stimulation (DBS) has widened the spectrum of therapeutical options for patients with otherwise intractable dystonia. It has been introduced only with a delay after DBS became an accepted treatment for advanced Parkinson' disease (PD). In this overview, the authors summarize the current status of its clinical application in dystonia. Deep brain stimulation for dystonia has been developed from radiofrequency lesioning, but it has replaced the latter largely in most centers. The main target used for primary dystonia is the posteroventral globus pallidus internus (GPi), and its efficacy has been shown in generalized dystonia, segmental dystonia, and complex cervical dystonia. The optimal target for secondary dystonias is still unclear, but some patients appear to benefit more from thalamic stimulation. The improvement of dystonia with chronic DBS frequently is delayed, in particular concerning tonic dystonic postures. Because more energy is needed for stimulation than in other movement disorders such as PD, more frequent battery replacements are necessary, which results in relatively higher costs for chronic DBS. The study of intraoperative microelectrode recordings and of local field potentials by the implanted DBS electrodes has yielded new insights in the pathophysiology of dystonia. Larger studies are underway presently to validate the observations being made. |
| Databáze: | OpenAIRE |
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