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Open Access 01-06-2020 | Dystonia | Original Communication

Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders

Authors: Simone Zittel, Ute Hidding, Maria Trumpfheller, Vanessa Lupici Baltzer, Alessandro Gulberti, Miriam Schaper, Maxine Biermann, Carsten Buhmann, Andreas K. Engel, Christian Gerloff, Manfred Westphal, Jana Stadler, Johannes A. Köppen, Monika Pötter-Nerger, Christian K. E. Moll, Wolfgang Hamel

Published in: Journal of Neurology | Issue 6/2020

Abstract

Background

Deep brain stimulation (DBS) within the pallidum represents an effective and well-established treatment for isolated dystonia. However, clinical outcome after surgery may be variable with limited response in 10–25% of patients. The effect of lead location on clinical improvement is still under debate.

Objective

To identify stimulated brain regions associated with the most beneficial clinical outcome in dystonia patients.

Methods

18 patients with cervical and generalized dystonia with chronic DBS of the internal pallidum were investigated. Patients were grouped according to their clinical improvement into responders, intermediate responders and non-responders. Magnetic resonance and computed tomography images were co-registered, and the volume of tissue activated (VTA) with respect to the pallidum of individual patients was analysed.

Results

VTAs in responders (n = 11), intermediate responders (n = 3) and non-responders (n = 4) intersected with the posterior internal (GPi) and external (GPe) pallidum and the subpallidal area. VTA heat maps showed an almost complete overlap of VTAs of responders, intermediate and non-responders. VTA coverage of the GPi was not higher in responders. In contrast, VTAs of intermediate and non-responders covered the GPi to a significantly larger extent in the left hemisphere (p < 0.01).

Conclusions

DBS of ventral parts of the posterior GPi, GPe and the adjacent subpallidal area containing pallidothalamic output projections resulted in favourable clinical effects. Of note, non-responders were also stimulated within the same area. This suggests that factors other than mere lead location (e.g., clinical phenotype, genetic background) have determined clinical outcome in the present cohort.

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Title: Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders
Authors: Simone Zittel
Ute Hidding
Maria Trumpfheller
Vanessa Lupici Baltzer
Alessandro Gulberti
Miriam Schaper
Maxine Biermann
Carsten Buhmann
Andreas K. Engel
Christian Gerloff
Manfred Westphal
Jana Stadler
Johannes A. Köppen
Monika Pötter-Nerger
Christian K. E. Moll
Wolfgang Hamel
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Dystonia
Deep Brain Stimulation
Published in: Journal of Neurology / Issue 6/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-020-09753-z

At a glance: The STEP trials

Springer Medicine

Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders

Abstract

Background

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

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