Neurotherapeutics

, Volume 5, Issue 2, pp 320–330 | Cite as

Treatment of dystonia with deep brain stimulation

Deep Brain Stimulation

Summary

Pallidal deep brain stimulation (DBS) is an established treatment option for medically refractive dystonia. The mechanism by which globus pallidus pars interna (GPi) DBS improves dystonia is still unclear. Primary generalized dystonia usually responds well to this therapy, as recently confirmed in two well-designed, double-blind, controlled trials; however, predictors of outcome within this population are not well known. The role of GPi DBS in idiopathic cervical dystonia resistant to treatment with botulinum toxin, in tardive dystonia, and in some types of secondary dystonia are emerging as populations of patients who may also benefit, but outcomes are not well documented. Serious complications from this therapy are rare. Future research will likely continue to address the most appropriate programming settings for various populations of dystonia, the mechanism by which DBS affects dystonia, and the possibility of alternative brain targets that might have less associated side effects or greater efficacy than the GPi.

Key Words

Dystonia deep brain stimulation surgical outcomes implantable device neuromodulation globus pallidus 

References

  1. 1.
    Fahn S, Bressman SB, Marsden CD. Classification of dystonia. Adv Neurol 1998;78: 1–10.PubMedGoogle Scholar
  2. 2.
    Ozelius LJ, Hewett JW, Page CE, Bressman SB, Kramer PL, Shalish C, de Leon D, Brin MF, Raymond D, Corey DP, Fahn S, Risch NJ, Buckler AJ, Gusella JF, Breakefield XO. The early-onset torsion dystonia gene (DYT1) encodes an ATP-binding protein. Nat Genet 1997;17: 40–48.CrossRefPubMedGoogle Scholar
  3. 3.
    Marsden CD, Obeso JA, Zarranz JJ, Lang AE. The anatomical basis of symptomatic hemidystonia. Brain 1985;108: 463–483.CrossRefPubMedGoogle Scholar
  4. 4.
    Asanuma K, Ma Y, Okulski J, et al. Decreased striatal D2 receptor binding in non-manifesting carriers of the DYT1 dystonia mutation. Neurology 2005;64: 347–349.PubMedGoogle Scholar
  5. 5.
    Eidelberg D, Moeller JR, Antonini A, et al. Functional brain networks in DYT1 dystonia. Ann Neurol 1998;44: 303–312.CrossRefPubMedGoogle Scholar
  6. 6.
    Starr PA, Rau GM, Davis V, et al. Spontaneous pallidal neuronal activity in human dystonia: comparison with Parkinson’s disease and normal macaque. J Neurophysiol 2005;93: 3165–3176.CrossRefPubMedGoogle Scholar
  7. 7.
    Silberstein P, Kühn AA, Kupsch A, et al. Patterning of globus pallidus local field potentials differs between Parkinson’s disease and dystonia. Brain 2003; 126: 2597–2608.CrossRefPubMedGoogle Scholar
  8. 8.
    Vitek JL, Chockkan V, Zhang JY, et al. Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol 1999;46: 22–35.CrossRefPubMedGoogle Scholar
  9. 9.
    Merello M, Cerquetti D, Cammarota A, et al. Neuronal globus pallidus activity in patients with generalised dystonia. Mov Disord 2004;19: 548–554.CrossRefPubMedGoogle Scholar
  10. 10.
    Sanghera MK, Grossman RG, Kalhorn CG, Hamilton WJ, Ondo WG, Jankovic J. Basal ganglia neuronal discharge in primary and secondary dystonia in patients undergoing pallidotomy. Neurosurgery 2003;52: 1358–1373.CrossRefPubMedGoogle Scholar
  11. 11.
    Tang JK, Moro E, Mahant N, et al. Neuronal firing rates and patterns in the globus pallidus intemus of patients with cervical dystonia differ from those with Parkinson’s disease. J Neurophysiol 2007;98: 720–729.CrossRefPubMedGoogle Scholar
  12. 12.
    LeDoux MS, Lorden JF. Abnormal spontaneous and harmaline-stimulated Purkinje cell activity in the awake genetically dystonic rat. Exp Brain Res 2002;145: 457–467.CrossRefPubMedGoogle Scholar
  13. 13.
    Burke RE, Fahn S. Double-blind evaluation of trihexyphenidyl in dystonia. Adv Neurol 1983;37: 189–192.PubMedGoogle Scholar
  14. 14.
    Burke RE, Fahn S, Marsden CD. Torsion dystonia: a double-blind, prospective trial of high-dosage trihexyphenidyl. Neurology 1986; 36: 160–164.PubMedGoogle Scholar
  15. 15.
    Nutt JG, Hammerstad JP, deGarmo P, Carter J. Cranial dystonia: double-blind crossover study of anticholinergics. Neurology 1984; 34: 215–217.PubMedGoogle Scholar
  16. 16.
    The National Institutes of Health Consensus Development Conference on Clinical Use of Botulinum Toxin Consensus Panel. Botulinum toxin. Consens Statement 1990;8(8): 1–20.Google Scholar
  17. 17.
    Albanese A, Barnes MP, Bhatia KP, et al. A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task Force. Eur J Neurol 2006;13: 433–444.CrossRefPubMedGoogle Scholar
  18. 18.
    Jankovic J. Botulinum toxin: clinical implication of antigenicity and immunoresistance. In: Brin MF, Jankovic J, Hallett M, Scientific and therapeutic aspects of botulinum toxin. Philadelphia: Lippincott Williams & Wilkins, 2002: 409–415.Google Scholar
  19. 19.
    Bertrand CM. Selective peripheral denervation for spasmodic torticollis: surgical technique, results, and observations in 260 cases. Surg Neurol 1993;40: 96–103.CrossRefPubMedGoogle Scholar
  20. 20.
    Ford B, Greene P, Louis ED, et al. Use of intrathecal baclofen in the treatment of patients with dystonia. Arch Neurol 1996;53: 1241–1246.PubMedGoogle Scholar
  21. 21.
    Walker RH, Danisi FO, Swope DM, Goodman RR, Germano IM, Brin MF. Intrathecal baclofen for dystonia: benefits and complications during six years of experience. Mov Disord 2000;15: 1242–1247.CrossRefPubMedGoogle Scholar
  22. 22.
    Albright AL, Barry MJ, Shafton DH, Ferson SS. Intrathecal baclofen for generalized dystonia. Dev Med Child Neurol 2001;43: 652–657.CrossRefPubMedGoogle Scholar
  23. 23.
    Cooper IS. 20-year follow-up study of the neurosurgical treatment of dystonia musculorum deformans. Adv Neurol 1976;14: 423–452.PubMedGoogle Scholar
  24. 24.
    Andrew J, Fowler CJ, Harrison MJG. Stereotaxic thalamotomy in 55 cases of dystonia. Brain 1983;106: 981–1000.CrossRefPubMedGoogle Scholar
  25. 25.
    Starr PA, Turner RS, Rau G, et al. Microelectrode-guided implantation of deep brain stimulators into the globus pallidus intemus for dystonia: techniques, electrode locations, and outcomes. J Neurosurg 2006;104: 488–501.CrossRefPubMedGoogle Scholar
  26. 26.
    Comella CL, Leurgans S, Wuu J, Stebbins GT, Chmura T; Dystonia Study Group. Rating scales for dystonia: a multicenter assessment. Mov Disord 2003;18: 303–312.CrossRefPubMedGoogle Scholar
  27. 27.
    Burke RE, Fahn S, Marsden CD, Bressman SB, Moskowitz C, Friedman J. Validity and reliability of a rating scale for the primary torsion dystonias. Neurology 1985;35: 73–77.PubMedGoogle Scholar
  28. 28.
    Comella CL, Stebbins GT, Goetz CG, Chmura TA, Bressman SB, Lang AE. Teaching tape for the motor section of the Toronto Western Spasmodic Torticollis Scale. Mov Disord 1997;12: 570–575.CrossRefPubMedGoogle Scholar
  29. 29.
    Vayssière N, Hemm S, Zanca M, et al. Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonia children. J Neurosurg 2000;93: 784–790.CrossRefPubMedGoogle Scholar
  30. 30.
    Bereznai B, Steude U, Seelos K, Bötzel K. Chronic high frequency globus pallidus intemus stimulation in different types of dystonia: a clinical, video, and MRI report of six patients presenting with segmental, cervical, and generalized dystonia. Mov Disord 2002; 17: 138–144.CrossRefPubMedGoogle Scholar
  31. 31.
    Vayssière N, van der Gaag N, Cif L, et al. Deep brain stimulation for dystonia confirming a somatotopic organization in the globus pallidus intemus. J Neurosurg 2004;101: 181–188.CrossRefPubMedGoogle Scholar
  32. 32.
    Vidailhet M, Vercueil L, Houeto JL, et al. Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. Lancet Neurol 2005;352: 459–467.Google Scholar
  33. 33.
    Ostrem JL, Marks WJ Jr, Volz MM, Heath SL, Starr PA. Pallidal deep brain stimulation in patients with cranial—cervical dystonia (Meige syndrome). Mov Disord 2007;22: 1885–1891.CrossRefPubMedGoogle Scholar
  34. 34.
    Kiss ZH, Doig-Beyaert K, Eliasziw M, Tsui J, Haffenden A, Suchowersky O; Functional and Stereotactic Section of the Canadian Neurosurgical Society; Canadian Movement Disorders Group. The Canadian multicentre study of deep brain stimulation for cervical dystonia. Brain 2007;130: 2879–2886.CrossRefPubMedGoogle Scholar
  35. 35.
    Tisch S, Zrinzo L, Limousin P, et al. Effect of electrode contact location on clinical efficacy of pallidal deep brain stimulation in primary generalised dystonia. J Neurol Neurosurg Psychiatry 2007;78: 1314–1319.CrossRefPubMedGoogle Scholar
  36. 36.
    Hung SW, Hamani C, Lozano AM, et al. Long-term outcome of bilateral pallidal deep brain stimulation for primary cervical dystonia. Neurology 2007;68: 457–459.CrossRefPubMedGoogle Scholar
  37. 37.
    Vercueil L, Houeto JL, Krystkowiak P, et al. Effects of pulse width variations in pallidal stimulation for primary generalized dystonia. J Neurol 2007;254: 1533–1537.CrossRefPubMedGoogle Scholar
  38. 38.
    Alterman RL, Miravite J, Weisz D, Shils JL, Bressman SB, Tagliati M. Sixty hertz pallidal deep brain stimulation for primary torsion dystonia. Neurology 2007;69: 681–688.CrossRefPubMedGoogle Scholar
  39. 39.
    Goto S, Mita S, Ushio Y. Bilateral pallidal stimulation for cervical dystonia: an optimal paradigm from our experiences. Stereotact Funct Neurosurg 2002;79: 221–227.CrossRefPubMedGoogle Scholar
  40. 40.
    Vidailhet M, Vercueil L, Houeto JL, et al. Bilateral, pallidal, deep-brain stimulation in primary generalised dystonia: a prospective 3 year follow-up study. Lancet Neurol 2007;6: 223–229.CrossRefPubMedGoogle Scholar
  41. 41.
    Kupsch A, Benecke R, Müller J, et al. Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 2006;355: 1978–1990.CrossRefPubMedGoogle Scholar
  42. 42.
    Diamond A, Shahed J, Azher S, Dat-Vuong K, Jankovic J. Globus pallidus deep brain stimulation in dystonia. Mov Disord 2006;21: 692–695.CrossRefPubMedGoogle Scholar
  43. 43.
    Bittar RG, Yianni J, Wang S, et al. Deep brain stimulation for generalised dystonia and spasmodic torticollis. J Clin Neurosci 2005;12: 12–16.CrossRefPubMedGoogle Scholar
  44. 44.
    Cif L, El Fertit H, Vayssière N, et al. Treatment of dystonic syndromes by chronic electrical stimulation of the internal globus pallidus. J Neurosurg Sci 2003;47: 52–55.PubMedGoogle Scholar
  45. 45.
    Yianni J, Bain PG, Gregory RP, et al. Post-operative progress of dystonia patients following globus pallidus intemus deep brain stimulation. Eur J Neurol 2003;10: 239–247.CrossRefPubMedGoogle Scholar
  46. 46.
    Vesper J, Klostermann F, Funk T, Stockhammer F, Brock M. Deep brain stimulation of the globus pallidus internus (GPi) for torsion dystonia: a report of two cases. Acta Neurochir Suppl 2002;79: 83–88.PubMedGoogle Scholar
  47. 47.
    Tronnier VM, Fogel W. Pallidal stimulation for generalized dystonia: report of three cases. J Neurosurg 2000;92: 453–456.CrossRefPubMedGoogle Scholar
  48. 48.
    Vercueil L, Pollak P, Fraix V, et al. Deep brain stimulation in the treatment of severe dystonia. J Neurol 2001;248: 695–700.CrossRefPubMedGoogle Scholar
  49. 49.
    Coubes P, Cif L, El Fertit H, et al. Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results. J Neurosurg 2004;101: 189–194.CrossRefPubMedGoogle Scholar
  50. 50.
    Eltahawy HA, Saint-Cyr J, Giladi N, Lang AE, Lozano AM. Primary dystonia is more responsive than secondary dystonia to pallidal interventions: outcome after pallidotomy or pallidal deep brain stimulation. Neurosurgery 2004;54: 613–619.CrossRefPubMedGoogle Scholar
  51. 51.
    Yianni J, Bain P, Giladi N, et al. Globus pallidus internus deep brain stimulation for dystonic conditions: a prospective audit. Mov Disord 2003;18: 436–442.CrossRefPubMedGoogle Scholar
  52. 52.
    Krauss JK, Loher TJ, Weigel R, Capelle HH, Weber S, Burgunder JM. Chronic stimulation of the globus pallidus internus for treatment of non-DYT1 generalized dystonia and choreoathetosis: 2-year follow-up. J Neurosurg 2003;98: 785–792.CrossRefPubMedGoogle Scholar
  53. 53.
    Krause M, Fogel W, Kloss M, Rasche D, Volkmann J, Tronnier V. Pallidal stimulation for dystonia. Neurosurgery 2004;55: 1361–1368; discussion 1368–1370.CrossRefPubMedGoogle Scholar
  54. 54.
    Katayama Y, Fukaya C, Kobayashi K, Oshima H, Yamamoto T. Chronic stimulation of the globus pallidus intemus for control of primary generalized dystonia. Acta Neurochir Suppl 2003;87: 125–128.PubMedGoogle Scholar
  55. 55.
    Zorzi G, Marras C, Nardocci N, et al. Stimulation of the globus pallidus intemus for childhood-onset dystonia. Mov Disord 2005; 20: 1194–1200.CrossRefPubMedGoogle Scholar
  56. 56.
    Kumar R, Dagher A, Hutchison WD, Lang AE, Lozano AM. Globus pallidus deep brain stimulation for generalized dystonia: clinical and PET investigation. Neurology 1999;53: 871–874.PubMedGoogle Scholar
  57. 57.
    Eltahawy HA, Saint-Cyr J, Giladi N, Lang AE, Lozano AM. Primary dystonia is more responsive than secondary dystonia to pallidal interventions: outcome after pallidotomy or pallidal deep brain stimulation. Neurosurgery 2004;54: 613–619; discussion 619–621.CrossRefPubMedGoogle Scholar
  58. 58.
    Işlekel S, Zileli M, Zileli B. Unilateral pallidal stimulation in cervical dystonia. Stereotact Funct Neurosurg 1999;72: 248–252.CrossRefPubMedGoogle Scholar
  59. 59.
    Krauss JK, Pohle T, Weber S, Ozdoba C, Burgunder J. Bilateral stimulation of the globus pallidus internus for treatment of cervical dystonia. Lancet 1999;354: 837–838.PubMedGoogle Scholar
  60. 60.
    Kulisevsky J, Lleó A, Gironell A, Molet J, Pascual-Sedano B, Parés P. Bilateral pallidal stimulation for cervical dystonia: dissociated pain and motor improvement. Neurology 2000;55: 1754–1755.PubMedGoogle Scholar
  61. 61.
    Krauss JK, Loher TJ, Pohle T, et al. Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy. J Neurol Neurosurg Psychiatry 2002; 72: 249–256.CrossRefPubMedGoogle Scholar
  62. 62.
    Kiss ZH, Doig K, Eliasziw M, Ranawaya R, Suchowersky O. The Canadian multicenter trial of pallidal deep brain stimulation for cervical dystonia: preliminary results in three patients. Neurosurg Focus 2004;17(1): E5.CrossRefPubMedGoogle Scholar
  63. 63.
    Goto S, Yamada K. Long term continuous bilateral pallidal stimulation produces stimulation independent relief of cervical dystonia. J Neurol Neurosurg Psychiatry 2004;75: 1506–1507.CrossRefPubMedGoogle Scholar
  64. 64.
    Hebb MO, Chiasson P, Lang AE, Brownstone RM, Mendez I. Sustained relief of dystonia following cessation of deep brain stimulation. Mov Disord 2007;22: 1958–1962.CrossRefPubMedGoogle Scholar
  65. 65.
    Muta D, Goto S, Nishikawa S, et al. Bilateral pallidal stimulation for idiopathic segmental axial dystonia advanced from Meige syndrome refractory to bilateral thalamotomy. Mov Disord 2001;16: 774–777.CrossRefPubMedGoogle Scholar
  66. 66.
    Houser M, Waltz T. Meige syndrome and pallidal deep brain stimulation. Mov Disord 2005;20: 1203–1205.CrossRefPubMedGoogle Scholar
  67. 67.
    Foote KD, Sanchez JC, Okun MS. Staged deep brain stimulation for refractory craniofacial dystonia with blepharospasm: case report and physiology. Neurosurgery 2005;56: E415; discussion E415.CrossRefPubMedGoogle Scholar
  68. 68.
    Opherk C, Gruber C, Steude U, Dichgans M, Bötzel K. Successful bilateral pallidal stimulation for Meige syndrome and spasmodic torticollis. Neurology 2006;66: E14.CrossRefPubMedGoogle Scholar
  69. 69.
    Castelnau P, Cif L, Valente EM, et al. Pallidal stimulation improves pantothenate kinase-associated neurodegeneration. Ann Neurol 2005;57: 738–741.CrossRefPubMedGoogle Scholar
  70. 70.
    Stair PA, Marks WJ, Lindsey N, Byrd D, Rau G, Turner R. Pallidal deep brain stimulation for dystonia: technical approach and magnetic resonance imaging verified electrode locations. Neurosurgery 2003;53: 494. Abstract.Google Scholar
  71. 71.
    Umemura A, Jaggi JL, Dolinskas CA, Stern MB, Baituch GH. Pallidal deep brain stimulation for longstanding severe generalized dystonia in Hallervorden-Spatz syndrome: case report. J Neurosurg 2004;100: 706–709.CrossRefPubMedGoogle Scholar
  72. 72.
    Trottenberg T, Paul G, Meissner W, Maier-Hauff K, Taschner C, Kupsch A. Pallidal and thalamic neurostimulation in severe tardive dystonia. J Neurol Neurosurg Psychiatry 2001;70: 557–559.CrossRefPubMedGoogle Scholar
  73. 73.
    Chouinard G, Margolese H. Manual for the Extrapyramidal Symptom Rating Scale (ESRS) [Erratum in: Schizophr Res 2006;85: 305]. Schizophr Res 2005;76: 247–265.CrossRefPubMedGoogle Scholar
  74. 74.
    Damier P, Thobois S, Witjas T, et al. Bilateral deep brain stimulation of the globus pallidus to treat tardive dyskinesia. Arch Gen Psychiatry 2007;64: 170–176.CrossRefPubMedGoogle Scholar
  75. 75.
    Magariños-Ascone CM, Regidor I, Martínez-Castrillo JC, Gómez-Galán M, Figueiras-Méndez R. Pallidal stimulation relieves myoclonus-dystonia syndrome. J Neurol Neurosurg Psychiatry 2005; 76: 989–991.CrossRefPubMedGoogle Scholar
  76. 76.
    Cif L, Valente EM, Hemm S, et al. Deep brain stimulation in myoclonus-dystonia syndrome. Mov Disord 2004;19: 724–727.CrossRefPubMedGoogle Scholar
  77. 77.
    Evidente VG, Lyons MK, Wheeler M, et al. First case of X-linked dystonia-parkinsonism (“Lubag”) to demonstrate a response to bilateral pallidal stimulation. Mov Disord 2007;22: 1790–1793.CrossRefPubMedGoogle Scholar
  78. 78.
    Deutschlander A, Asmus F, Gasser T, Steude U, Bötzel K. Sporadic rapid-onset dystonia-parkinsonism syndrome: failure of bilateral pallidal stimulation. Mov Disord 2005;20: 254–257.CrossRefPubMedGoogle Scholar
  79. 79.
    Loher TJ, Hasdemir MG, Burgunder JM, Krauss JK. Long-term follow-up study of chronic globus pallidus intemus stimulation for posttraumatic hemidystonia. J Neurosurg 2000;92: 457–460.CrossRefPubMedGoogle Scholar
  80. 80.
    Chang JW, Choi JY, Lee BW, Kang UJ, Chung SS. Unilateral globus pallidus intemus stimulation improves delayed onset post-traumatic cervical dystonia with an ipsilateral focal basal ganglia lesion. J Neurol Neurosurg Psychiatry 2002;73: 588–590.CrossRefPubMedGoogle Scholar
  81. 81.
    Detante O, Vercueil L, Thobois S, et al. Globus pallidus internus stimulation in primary generalized dystonia: a H2 15O PET study. Brain 2004;127: 1899–1908.CrossRefPubMedGoogle Scholar
  82. 82.
    Silay K, Larson P, Starr P. Deep brain stimulator infections: incidence and management in a large series. Neurosurgery 2008 (in press).Google Scholar
  83. 83.
    Yianni J, Nandi D, Shad A, Bain P, Gregory R, Aziz T. Increased risk of lead fracture and migration in dystonia compared with other movement disorders following deep brain stimulation. J Clin Neurosci 2004; 11: 243–245.CrossRefPubMedGoogle Scholar
  84. 84.
    Ghika J, Villemure JG, Fankhauser H, Favre J, Assal G, Ghika-Schmid F. Efficiency and safety of bilateral contemporaneous pallidal stimulation (deep brain stimulation) in levodopa-responsive patients with Parkinson’s disease with severe motor fluctuations: a 2-year follow-up review. J Neurosurg 1998;89: 713–718.CrossRefPubMedGoogle Scholar
  85. 85.
    Sellai F, Hirsch E, Barth P, Blond S, Marescaux C. A case of symptomatic hemidystonia improved by ventroposterolateral thalamic electrostimulation. Mov Disord 1993;8: 515–518.CrossRefGoogle Scholar
  86. 86.
    Loher TJ, Krauss JK, Burgunder JM, Taub E, Siegfried J. Chronic thalamic stimulation for treatment of dystonic paroxysmal nonkinesigenic dyskinesia. Neurology 2001;56: 268–270.PubMedGoogle Scholar
  87. 87.
    Nikkhah G, Prokop T, Hellwig B, Lücking CH, Ostertag CB. Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions: report of two cases. J Neurosurg 2004;100: 1079–1083.CrossRefPubMedGoogle Scholar
  88. 88.
    Fukaya C, Katayama Y, Kano T, et al. Thalamic deep brain stimulation for writer’s cramp. J Neurosurg 2007; 107: 977–982.CrossRefPubMedGoogle Scholar
  89. 89.
    Taira T, Hori T. Stereotactic ventrooralis thalamotomy for task-specific focal hand dystonia (writer’s cramp). Stereotact Funct Neurosurg 2003;80: 88–91.CrossRefPubMedGoogle Scholar
  90. 90.
    Kleiner-Fisman G, Liang GS, Moberg PJ, et al. Subthalamic nucleus deep brain stimulation for severe idiopathic dystonia: impact on severity, neuropsychological status, and quality of life. J Neurosurg 2007;107: 29–36.CrossRefPubMedGoogle Scholar
  91. 91.
    Chou KL, Hurtig HI, Jaggi JL, Baltuch GH. Bilateral subthalamic nucleus deep brain stimulation in a patient with cervical dystonia and essential tremor. Mov Disord 2005;20: 377–380.CrossRefPubMedGoogle Scholar
  92. 92.
    Pastor-Gómez J, Hernando-Requejo V, Luengo Dos Santos A, Pedrosa-Sánchez M, Sola RG. Treatment of a case of generalized dystonia using subthalamic stimulation [In Spanish]. Rev Neurol 2003;37: 529–531.PubMedGoogle Scholar
  93. 93.
    Detante O, Vercueil L, Krack P, Chabardes S, Benabid AL, Pollak P. Off-period dystonia in Parkinson’s disease but not generalized dystonia is improved by high-frequency stimulation of the subthalamic nucleus. Adv Neurol 2004;94: 309–314.PubMedGoogle Scholar
  94. 94.
    Sun B, Chen S, Zhan S, Le W, Krahl S. Subthalamic nucleus stimulation for primary dystonia and tardive dystonia. Acta Neurochir Suppl 2007;97: 207–214.CrossRefPubMedGoogle Scholar
  95. 95.
    Novak KE, Nenonene EK, Bernstein LP, Vergenz S, Cozzens JW, Rezak M. Successful bilateral subthalamic nucleus stimulation for segmental dystonia after unilateral pallidotomy. Stereotact Funct Neurosurg 2007;86: 80–86.CrossRefPubMedGoogle Scholar
  96. 96.
    Kupsch A, Klaffke S, Kühn AA, et al. The effects of frequency in pallidal deep brain stimulation for primary dystonia [Erratum in: J Neurol 2004;251:1031]. J Neurol 2003;250: 1201–1205.CrossRefPubMedGoogle Scholar
  97. 97.
    Grips E, Blahak C, Capelle HH, et al. Patterns of reoccurrence of segmental dystonia after discontinuation of deep brain stimulation. J Neurol Neurosurg Psychiatry 2007;78: 318–320.CrossRefPubMedGoogle Scholar
  98. 98.
    Zhang JG, Zhang K, Wang ZC, Ge M, Ma Y. Deep brain stimulation in the treatment of secondary dystonia. Chin Med J 2006; 119: 2069–2074.PubMedGoogle Scholar

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2008

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of CaliforniaSan Francisco
  2. 2.Parkinson’s Disease ResearchEducation and Clinical Center (PADRECC)San Francisco
  3. 3.Department of Neurological SurgeryUniversity of CaliforniaSan Francisco

Personalised recommendations