Abstract
Background
Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has become an accepted treatment for severe cervical dystonia (CD). Assessment of therapeutic efficacy of DBS mostly focused on head position at rest but hardly on limitations of head and neck mobility, which represent a functionally important impairment in CD.
Objective
We aimed to determine prospectively head and neck range of motion (ROM) preoperatively and during chronic bilateral GPi DBS in a series of 11 patients with idiopathic CD or segmental dystonia with prominent CD using a computerized motion analysis.
Methods
Maximum horizontal rotation of the head in the transverse plane and lateral inclination in the frontal plane were measured preoperatively and at a median of 7 months of chronic GPi DBS, using an ultrasound-based three-dimensional measuring system combined with surface electromyography of cervical muscles.
Results
Horizontal rotation of the head increased from 78.8° ± 31.5° (mean ± SD) preoperatively to 100.7° ± 24.7° with GPi DBS (p < 0.01), thereby improvement of head rotation to the anti-dystonic side (+ 14,2° ± 12,2°) was greater than to the pro-dystonic side (+ 7,8° ± 9,2°; p < 0.05). Movement-related agonistic-antagonistic EMG modulation during head rotation was enhanced with GPi DBS in both sternocleidomastoid (modulation index (MI) 35.8% ± 26.7% preoperatively vs. 67.3% ± 16.9% with GPi DBS, p < 0.01), and splenius capitis muscles (MI 1.9% ± 24.5% preoperatively vs. 44.8% ± 11.6% with GPi DBS, p < 0.01).
Conclusion
Chronic bilateral GPi DBS significantly improves head ROM in CD, likely due to enhanced agonist–antagonist EMG activity with reduced co-contraction. Computerized motion analysis provides an objective measurement to assess the improvement of head and neck mobility in CD.
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All original data are available from the authors upon request.
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CB: conception and design of the work; data acquisition; analysis and interpretation of data; draft of manuscript. MEW: data acquisition; revision of manuscript. AS: data acquisition; revision of manuscript. HB: conception and design of the work; revision of manuscript. JKK: conception and design of the work; draft and revision of manuscript.
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J. K. Krauss is a consultant to Medtronic and Boston Scientific, he received honoraria for speaking from AbbVie. C. Blahak received travel grants from Ipsen, A. Saryyeva received travel grants from Medtronic. The other authors report no financial disclosures.
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Blahak, C., Wolf, M.E., Saryyeva, A. et al. Improvement of head and neck range of motion induced by chronic pallidal deep brain stimulation for cervical dystonia. J Neural Transm 128, 1205–1213 (2021). https://doi.org/10.1007/s00702-021-02365-5
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DOI: https://doi.org/10.1007/s00702-021-02365-5