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Different clinical course of pallidal deep brain stimulation for phasic- and tonic-type cervical dystonia

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Abstract

Background

Dystonia has been treated well using deep brain stimulation at the globus pallidus internus (GPi DBS). Dystonia can be categorized as two basic types of movement, phasic-type and tonic-type. Cervical dystonia is the most common type of focal dystonia, and sequential differences in clinical outcomes between phasic-type and tonic-type cervical dystonia have not been reported.

Methods

This study included a retrospective cohort of 30 patients with primary cervical dystonia who underwent GPi DBS. Age, disease duration, dystonia direction, movement types, employment status, relevant life events, and neuropsychological examinations were analyzed with respect to clinical outcomes following GPi DBS.

Results

The only significant factor affecting clinical outcomes was movement type (phasic or tonic). Sequential changes in clinical outcomes showed significant differences between phasic- and tonic-type cervical dystonia. A delayed benefit was found in both phasic- and tonic-type dystonia.

Conclusions

The clinical outcome of phasic-type cervical dystonia is more favorable than that of tonic-type cervical dystonia following GPi DBS.

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Authors and Affiliations

  1. Department of Neurosurgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, #56 Dongsuro Bupyeong-Gu, Incheon, 403-720, South Korea

    Moonyoung Chung & Ryoong Huh

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  1. Moonyoung Chung
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  2. Ryoong Huh
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Correspondence to Ryoong Huh.

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Moonyoung Chung has no financial disclosure.

Ryoong Huh has no financial disclosure.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Comments

In this interesting study, the authors retrospectively review the clinical data of 30 patients affected by primary cervical dystonia who underwent globus pallidus internus (GPi) deep brain stimulation (DBS). This study provides some important information on this topic. The only significant factor affecting clinical outcomes was the dystonia type (phasic or tonic). A benefit was actually found for both types of cervical dystonia, but the clinical outcome of phasic-type cervical dystonia is more favorable. Intriguingly, a delayed benefit was found in both phasic- and tonic-type dystonia. This study has the merit of being conducted in a large and homogenous patient group and to demonstrate the persistence of benefit and even a delayed improvement in both dystonia types. Furthermore, it provides interesting considerations about the mechanisms underlying DBS neuromodulation. It has been suggested that DBS causes a “depolarization block” by high-frequency stimulation of neurons above their maximum firing rate inducing continuous depolarization and conduction block. Nevertheless, this interpretation does not appear completely satisfactory. Indeed, several stimulation-induced side effects, such as visual flushing, tetanic muscle contraction, and paresthesia, seemingly originates from neural activations rather than from neural block. Other possible explanations should therefore be considered. For instance, the effects of DBS on phasic-types dystonia could be the result of desynchronization of a pathologic low-frequency oscillatory activity of the central motor network. Furthermore, the distinctive feature of a delayed benefit of GPi DBS in dystonia patients suggests that this procedure can modulate neural plasticity in a manner that deserves further studies.

Alfredo Conti

Messina, Italy

Some of data of this study have been presented in 55th congress of Korean Society of Neurosurgeon at Oct. 17, 2015.

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Chung, M., Huh, R. Different clinical course of pallidal deep brain stimulation for phasic- and tonic-type cervical dystonia. Acta Neurochir 158, 171–180 (2016). https://doi.org/10.1007/s00701-015-2646-7

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  • DOI: https://doi.org/10.1007/s00701-015-2646-7

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