Parkinsonian signs in patients with cervical dystonia treated with pallidal deep brain stimulation

Brain : a Journal of Neurology
Philipp MahlknechtPatricia Limousin

Abstract

Pallidal deep brain stimulation is an established treatment in patients with dystonia. However, evidence from case series or uncontrolled studies suggests that it may lead in some patients to specific parkinsonian symptoms such as freezing of gait, micrographia, and bradykinesia. We investigated parkinsonian signs using the Movement Disorder Society Unified Parkinson's Disease Rating Scale motor score by means of observer-blinded video ratings in a group of 29 patients treated with pallidal stimulation and a non-surgical control group of 22 patients, both with predominant cervical dystonia. Additional assessments included MRI-based models of volume of neural tissue activated to investigate areas of stimulation related to dystonic symptom control and those likely to induce parkinsonian signs as well as an EMG analysis to investigate functional vicinity of stimulation fields to the pyramidal tract. Compared with controls, stimulated patients had significantly higher motor scores (median, 25th-75th percentile: 14.0, 8.0-19.5 versus 3.0, 2.0-8.0; P < 0.0001), as well as bradykinesia (8.0, 6.0-14.0 versus 2.0, 0.0-3.0; P < 0.0001) and axial motor subscores (2.0, 1.0-4.0 versus 0.0, 0.0-1.0; P = 0.0002), while rigidity and tremor sub...Continue Reading

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Citations

Nov 20, 2019·Brain : a Journal of Neurology·Zuzana KosutzkaMarie Vidailhet
Nov 20, 2019·Brain : a Journal of Neurology·Philipp MahlknechtPatricia Limousin
Oct 2, 2020·Movement Disorders : Official Journal of the Movement Disorder Society·Takashi TsuboiErik H Middlebrooks
Jan 16, 2020·Journal of Neurology·Takashi TsuboiAdolfo Ramirez-Zamora
Jul 9, 2020·Experimental Brain Research·Stephen Tisch, Patricia Limousin
Oct 28, 2019·Brain : a Journal of Neurology·Daniel WeissSimon J G Lewis
Jun 3, 2021·Parkinsonism & Related Disorders·Eoin MulroyPatricia Limousin

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