Outcome of deep brain stimulation in slowly progressive multiple system atrophy: A clinico-pathological series and review of the literature

Parkinsonism & Related Disorders
Wassilios G MeissnerStéphane Thobois

Abstract

To highlight the risk of clinical worsening after deep brain stimulation in histologically proven multiple system atrophy (MSA) patients presenting slow and relatively benign disease progression mimicking Parkinson's disease (PD). In such cases but also in more typical MSA patients, the results of deep brain stimulation have been mostly reported as case reports and small patient series. The present study describes the outcome of the largest series of histologically proven MSA patients who underwent deep brain stimulation (DBS) of the subthalamic nucleus because they were considered as having PD at the time of surgery. Three patients showed significant improvement of motor signs after surgery while two did not. Clinical improvement was short-lasting and rapidly followed by the occurrence of disabling manifestations of MSA that counteracted DBS benefits. Together with previous reports, our study demonstrates that DBS should not be recommended for MSA patients. It also underlines that detecting subtle red flags is crucial to avoid DBS surgery in this population.

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Citations

Oct 7, 2017·Journal of Alzheimer's Disease : JAD·Kurt A Jellinger
Feb 24, 2018·Movement Disorders : Official Journal of the Movement Disorder Society·Patrice PéranOlivier Rascol
Aug 29, 2018·Movement Disorders : Official Journal of the Movement Disorder Society·Amit BatlaKailash P Bhatia
Aug 30, 2017·Acta Neuropathologica·Amanda L WoermanStanley B Prusiner
Jun 3, 2020·Fortschritte der Neurologie-Psychiatrie·Lara Stute, Rejko Krüger
Mar 28, 2017·Journal of Neural Transmission·Rejko KrügerPeter Riederer
Jul 28, 2018·CNS Drugs·Nikolaos Giagkou, Maria Stamelou
May 16, 2019·Journal of Neural Transmission·Wolfgang H JostAnette Schrag
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Nov 7, 2019·Movement Disorders : Official Journal of the Movement Disorder Society·Wassilios G MeissnerOlivier Rascol
May 11, 2018·Current Opinion in Neurology·Gesine RespondekGünter U Höglinger
Sep 1, 2020·Parkinsonism & Related Disorders·Graziella MangoneUNKNOWN contributors/investigators
Sep 16, 2017·Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine·Philipp T MeyerSabine Hellwig

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