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The effect of electrode contact location on clinical efficacy of pallidal deep brain stimulation in primary generalised dystonia
  1. Stephen Tisch (s.tisch{at}ion.ucl.ac.uk)
  1. Institute of Neurology, University College London, United Kingdom
    1. Ludvic Zrinzo (luz{at}dr.com)
    1. Institute of Neurology, University College London, United Kingdom
      1. Patricia Limousin (p.limousin{at}ion.ucl.ac.uk)
      1. Institute of Neurology, United Kingdom
        1. Kailash P Bhatia (k.bhatia{at}ion.ucl.ac.uk)
        1. Institute of Neurology, United Kingdom
          1. Niall Quinn (n.quinn{at}ion.ucl.ac.uk)
          1. Institute of Neurology, United Kingdom
            1. Keyoumars Ashkan (keyoumars.ashkan{at}kch.nhs.uk)
            1. Institute of Neurology, United Kingdom
              1. Marwan Hariz (m.hariz{at}ion.ucl.ac.uk)
              1. Institute of Neurology, United Kingdom

                Abstract

                Objectives: To determine the effect of electrode contact location on efficacy of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) for primary generalised dystonia (PGD).

                Subjects and methods: A consecutive series of 15 patients with PGD (10 female, mean age 42 years, 7 DYT1) who underwent bilateral GPi DBS, were assessed using the Burke-Fahn-Marsden (BFM) dystonia scale before and 6 months after surgery. The position of the stimulated electrode contact(s) was determined from the post-operative stereotactic MRI. Contralateral limb and total axial BFM subscores were compared with the location of the stimulated contact(s) within GPi.

                Results: The mean total BFM score decreased from 38.9 preoperatively to 11.9 at 6 months, a 69.5% improvement (p<0.00001). Cluster analysis of the stimulated contact coordinates identified two groups, distributed along an anterodorsal to posteroventral axis. Clinical improvement was greater for posteroventral than anterodorsal stimulation for the arm (86% vs 52% p <0.05) and trunk (96% vs 65%, p<0.05) and inversely correlated with the y coordinate. For the leg, posteroventral and anterodorsal stimulation were of equivalent efficacy. Overall clinical improvement was maximal with posteroventral stimulation (89% vs 67%, p<0.05) and inversely correlated with y (A-P) coordinate (r=-0.62, p<0.05).

                Conclusion: GPi DBS is effective for PGD but outcome is dependent on contact location. Posteroventral GPi stimulation provides the best overall effect and is superior for the arm and trunk. These results may be explained by the functional anatomy of GPi and its outflow tracts.

                • GPi DBS
                • dystonia
                • electrode contact location

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