Abstract
Pallidal deep brain stimulation is a well-known surgical treatment for cervical dystonia. The resolution of dystonia typically requires bilateral pallidal stimulation, but in some instances, unilateral stimulation has been successful. In such instances, generally, the stimulated hemisphere was contralateral to the dystonic sternocleidomastoid, but rarely it was ipsilateral. We sought for the physiological features that determine the basis for success and laterality of deep brain stimulation for cervical dystonia with prominent torticollis. We found that pallidal physiology such as high burst to tonic ratio and significant interhemispheric differences in the neuronal firing rate and regularity are critical determinants of successful treatment with unilateral deep brain stimulation. We also found that higher lateralized differences in pallidal physiological parameters predict more robust improvement. In three out of four patients, the stimulation of the hemisphere ipsilateral to the dystonic sternocleidomastoid muscle was effective. These patients did not have any structural brain abnormalities on clinically available imaging studies. One patient responded to the unilateral deep brain stimulation in the hemisphere contralateral to the dystonic sternocleidomastoid. This patient had a structural putamen lesion on brain MRI. These results provide objective parameters determining the success of pallidal deep brain stimulation for treatment of cervical dystonia. The results also depict differences in the pallidal physiology in patients where ipsilateral versus contralateral deep brain stimulation was effective.
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Financial Disclosure and Conflict of Interest
The authors have no conflicts of interests. Shaikh serves on speaker bureau for Acorda Pharmaceuticals. Jinnah is consultant for Retrophin Inc., CoA Therapeutics, and Cavion Therapeutics.
Funding
The study was funded by the Russian Science Foundation (project 18-15-00009, Sedov): MER data collection and analysis. The study was partly supported by the Russian Science Foundation (project 23-25-00406, Semenova): Lead-DBS analysis. Shaikh was supported by the Career Development Grant from the American Academy of Neurology, George C. Cotzias Memorial Fellowship, Network Models in Dystonia grant from the Dystonia Medical Research Foundation, Department of VA Merit Review (I01CX002086), and philanthropic funds to the Department of Neurology at University Hospitals (Penni and Stephen Weinberg Chair in Brain Health and Woll Fund).
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Sedov, A. et al. (2023). Does Pallidal Physiology Determine the Success of Unilateral Deep Brain Stimulation in Cervical Dystonia?. In: Shaikh, A., Sadnicka, A. (eds) Basic and Translational Applications of the Network Theory for Dystonia. Advances in Neurobiology, vol 31. Springer, Cham. https://doi.org/10.1007/978-3-031-26220-3_12
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DOI: https://doi.org/10.1007/978-3-031-26220-3_12
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