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J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-302309
  • Movement disorders
  • Research paper

Movement kinematic after deep brain stimulation associated microlesions

  1. Kai Bötzel1,2
  1. 1Department of Neurology, Ludwig-Maximilian University, Munich, Germany
  2. 2Graduate School of Systemic Neurosciences, Ludwig-Maximilian University, Munich, Germany
  3. 3Department of Neurosurgery, Ludwig-Maximilian University, Munich, Germany
  1. Correspondence to Professor Dr Kai Bötzel, Department of Neurology, Klinikum Großhadern, Ludwig-Maximilian University, Marchioninistr. 15, 81377 Munich, Germany; kai.boetzel{at}med.uni-muenchen.de

  1. Contributors KB had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. AS, SK, JHM and KB participated in the conception and design of the study. AS and KB analysed and interpreted the data. AS provided methodological and statistical expertise and critically reviewed the paper. AS and KB wrote the manuscript and provided important intellectual content.

  • Received 17 January 2012
  • Revised 12 June 2012
  • Accepted 10 July 2012
  • Published Online First 6 August 2012

Abstract

Backgrounds Deep brain stimulation is widely used for the treatment of movement disorders such as Parkinson's disease and dystonia. After the implantation of electrodes an immediate improvement of clinical symptoms has been described. It is unclear, whether movement kinematics are also changed by this ‘microlesion effect’.

Methods To gain further insight into these mechanisms, we studied arm, hand and finger movements preoperatively and immediately after the implantation of deep brain stimulation electrodes in patients with Parkinson's disease and dystonia.

Results After implantation and without stimulation there was a clear reduction of clinical symptoms in both groups, as has been described previously. However, movement velocity was affected differently. Parkinsonian patients showed increased movement velocity postoperatively, whereas dystonic patients were significantly slower after electrode implantation.

Conclusions Lesioning and stimulation of these structures have the same beneficial clinical effects. Furthermore we suggest that globus pallidus internum lesions act by inhibiting a system which mainly acts upon muscular tone and limb posture whereas subthalamic stimulation or lesion causes a more unspecific disinhibition of movements.

Footnotes

  • Funding Supported by grants from the Lüneburg heritage.

  • Competing interests JHM and KB have received speaker honoraria from Medtronic, Inc.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee of the medical faculty of the Ludwig-Maximilian University, Munich.

  • Provenance and peer review Not commissioned; externally peer reviewed.