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01-06-2020 | Torticollis Spasticus | Original Communication

Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis

Authors: Xing Hua, Bohan Zhang, Zhicheng Zheng, Houyou Fan, Linfeng Luo, Xiaosi Chen, Jian Duan, Dongwei Zhou, Meihua Li, Tao Hong, Guohui Lu

Published in: Journal of Neurology | Issue 6/2020

Abstract

Background

Deep brain stimulation (DBS) therapy has been suggested to be a beneficial alternative in cervical dystonia (CD) for patients who failed nonsurgical treatments. This individual patient data meta-analysis compared the efficacy of DBS in the globus pallidus internus (GPi) versus subthalamic nucleus (STN) and identified possible predictive factors for CD.

Methods

Three electronic databases (PubMed, Embase and Web of Science) were searched for studies with no publication date restrictions. The primary outcomes were normalized by calculating the relative change in TWSTRS total scores and subscale scores at the last follow-up. Data were analyzed mainly using Pearson’s correlation coefficients and a stepwise multivariate regression analysis.

Results

Thirteen studies (86 patients, 58 with GPi-DBS and 28 with STN-DBS) were eligible. Patients showed significant improvement in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) (52.5 ± 11.6 vs 21.9 ± 14.9, P < 0.001) scores at the last follow-up (22.0 ± 14.3 months), compared with scores at baseline, with a mean improvement of 56.6% (P < 0.001) (54.9% in severity, 63.2% in disability, 41.7% in pain). There was no significant difference in the improvement (%) of the total TWSTRS scores in 3 years for the GPI and STN groups (58.1 ± 22.6 vs 47.5 ± 39.2, P > 0.05). Age at surgery and age at symptom onset were negatively correlated with the relative changes in TWSTRS scores at the last follow-up, while there was a positive correlation with preoperative TWSTRS scores. On the stepwise multivariate regression, only the age at surgery remained significant in the best predictive model.

Conclusions

GPi-DBS and STN-DBS both provided a common great improvement in the symptoms of CD patients in 3 years. Earlier age at surgery may probably indicate larger improvement. More randomized large-scale clinical trials are warranted in the future.

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Jankovic J, Leder S, Warner D, Schwartz K (1991) Cervical dystonia: clinical findings and associated movement disorders. Neurology 41(7):1088–1091. https://doi.org/10.1212/wnl.41.7.1088 CrossRefPubMed

Chan J, Brin MF, Fahn S (1991) Idiopathic cervical dystonia: clinical characteristics. Mov Disord 6(2):119–126. https://doi.org/10.1002/mds.870060206 CrossRefPubMed

Warner T, Camfield L, Marsden CD, Nemeth AH, Hyman N, Harley D, Wissel J, Poewe W, Marttila RJ, Erjanti H, Burbaud P, Lagueny A, Kamm C, Gasser T, Franz P, Castelon-Konkiewitz E, Trender I, Ceballos-Baumann A, Nebe A, Fruedenberg B, Bentivoglio A, Cassetta E, Albanese A, Curra A, Vacca L, Berardelli A, Ferreira J, Sampaio C, Passao V, Marti F, Tolosa E, Claveria L, Duarte J, Warner T, Ben-Shlomo Y, Newton A (2000) A prevalence study of primary dystonia in eight European countries. J Neurol 247(10):787–792. https://doi.org/10.1007/s004150070094 CrossRef

Jankovic J, Tsui J, Bergeron C (2007) Prevalence of cervical dystonia and spasmodic torticollis in the United States general population. Parkinsonism Relat Disord 13(7):411–416. https://doi.org/10.1016/j.parkreldis.2007.02.005 CrossRefPubMed

Nutt JG, Muenter MD, Aronson A, Kurland LT, Melton LJ 3rd (1988) Epidemiology of focal and generalized dystonia in Rochester, Minnesota. Mov Disord 3(3):188–194. https://doi.org/10.1002/mds.870030302 CrossRefPubMed

Andrews C, Aviles-Olmos I, Hariz M, Foltynie T (2010) Which patients with dystonia benefit from deep brain stimulation? A metaregression of individual patient outcomes. J Neurol Neurosurg Psychiatry 81(12):1383–1389. https://doi.org/10.1136/jnnp.2010.207993 CrossRefPubMed

Ben-Shlomo Y, Camfield L, Warner T (2002) What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry 72(5):608–614. https://doi.org/10.1136/jnnp.72.5.608 CrossRefPubMedPubMedCentral

Camfield L, Ben-Shlomo Y, Warner TT (2002) Impact of cervical dystonia on quality of life. Mov Disord 17(4):838–841. https://doi.org/10.1002/mds.10127 CrossRefPubMed

Albanese A, Asmus F, Bhatia KP, Elia AE, Elibol B, Filippini G, Gasser T, Krauss JK, Nardocci N, Newton A, Valls-Sole J (2011) EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol 18(1):5–18. https://doi.org/10.1111/j.1468-1331.2010.03042.x CrossRefPubMed

10.

Greene P, Fahn S, Diamond B (1994) Development of resistance to botulinum toxin type A in patients with torticollis. Mov Disord 9(2):213–217. https://doi.org/10.1002/mds.870090216 CrossRefPubMed

11.

Bentivoglio AR, Di Stasio E, Mulas D, Cerbarano ML, Ialongo T, Laurienzo A, Petracca M (2017) Long-term abobotulinum toxin A treatment of cervical dystonia. Neurotox Res 32(2):291–300. https://doi.org/10.1007/s12640-017-9737-6 CrossRefPubMed

12.

Yianni J, Bain P, Giladi N, Auca M, Gregory R, Joint C, Nandi D, Stein J, Scott R, Aziz T (2003) Globus pallidus internus deep brain stimulation for dystonic conditions: a prospective audit. Mov Disord 18(4):436–442. https://doi.org/10.1002/mds.10380 CrossRefPubMed

13.

Eltahawy HA, Saint-Cyr J, Poon YY, Moro E, Lang AE, Lozano AM (2004) Pallidal deep brain stimulation in cervical dystonia: clinical outcome in four cases. Can J Neurol Sci 31(3):328–332. https://doi.org/10.1017/S0317167100003401 CrossRefPubMed

14.

Kiss ZH, Doig K, Eliasziw M, Ranawaya R, Suchowersky O (2004) The Canadian multicenter trial of pallidal deep brain stimulation for cervical dystonia: preliminary results in three patients. Neurosurg Focus 17(1):E5CrossRefPubMed

15.

Kleiner-Fisman G, Liang GS, Moberg PJ, Ruocco AC, Hurtig HI, Baltuch GH, Jaggi JL, Stern MB (2007) Subthalamic nucleus deep brain stimulation for severe idiopathic dystonia: impact on severity, neuropsychological status, and quality of life. J Neurosurg 107(1):29–36. https://doi.org/10.3171/jns-07/07/0029 CrossRefPubMed

16.

Ostrem JL, Marks WJ Jr, Volz MM, Heath SL, Starr PA (2007) Pallidal deep brain stimulation in patients with cranial–cervical dystonia (Meige syndrome). Mov Disord 22(13):1885–1891. https://doi.org/10.1002/mds.21580 CrossRefPubMed

17.

Loher TJ, Capelle HH, Kaelin-Lang A, Weber S, Weigel R, Burgunder JM, Krauss JK (2008) Deep brain stimulation for dystonia: outcome at long-term follow-up. J Neurol 255(6):881–884. https://doi.org/10.1007/s00415-008-0798-6 CrossRefPubMed

18.

Berman BD, Starr PA, Marks WJ Jr, Ostrem JL (2009) Induction of bradykinesia with pallidal deep brain stimulation in patients with cranial-cervical dystonia. Stereotact Funct Neurosurg 87(1):37–44. https://doi.org/10.1159/000195718 CrossRefPubMedPubMedCentral

19.

Cacciola F, Farah JO, Eldridge PR, Byrne P, Varma TK (2010) Bilateral deep brain stimulation for cervical dystonia: long-term outcome in a series of 10 patients. Neurosurgery 67(4):957–963. https://doi.org/10.1227/NEU.0b013e3181ec49c7 CrossRefPubMed

20.

Ostrem JL, Racine CA, Glass GA, Grace JK, Volz MM, Heath SL, Starr PA (2011) Subthalamic nucleus deep brain stimulation in primary cervical dystonia. Neurology 76(10):870–878. https://doi.org/10.1212/WNL.0b013e31820f2e4f CrossRefPubMed

21.

Sadnicka A, Kimmich O, Pisarek C, Ruge D, Galea J, Kassavetis P, Parees I, Saifee T, Molloy A, Bradley D, O'Riordan S, Zrinzo L, Hariz M, Bhatia KP, Limousin P, Foltynie T, Rothwell JC, Hutchinson M, Edwards MJ (2013) Pallidal stimulation for cervical dystonia does not correct abnormal temporal discrimination. Mov Disord 28(13):1874–1877. https://doi.org/10.1002/mds.25581 CrossRefPubMed

22.

Ostrem JL, Markun LC, Glass GA, Racine CA, Volz MM, Heath SL, de Hemptinne C, Starr PA (2014) Effect of frequency on subthalamic nucleus deep brain stimulation in primary dystonia. Parkinsonism Relat Disord 20(4):432–438. https://doi.org/10.1016/j.parkreldis.2013.12.012 CrossRefPubMed

23.

Ostrem JL, San Luciano M, Dodenhoff KA, Ziman N, Markun LC, Racine CA, de Hemptinne C, Volz MM, Heath SL, Starr PA (2017) Subthalamic nucleus deep brain stimulation in isolated dystonia: a 3-year follow-up study. Neurology 88(1):25–35. https://doi.org/10.1212/wnl.0000000000003451 CrossRefPubMed

24.

Huh R, Song IU, Chung M (2018) Neuropsychological consequences of pallidal deep brain stimulation altering brain networks. J Clin Neurosci 54:50–56. https://doi.org/10.1016/j.jocn.2018.05.004 CrossRefPubMed

25.

Schjerling L, Hjermind LE, Jespersen B, Madsen FF, Brennum J, Jensen SR, Lokkegaard A, Karlsborg M (2013) A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia. J Neurosurg 119(6):1537–1545. https://doi.org/10.3171/2013.8.Jns13844 CrossRefPubMed

26.

Liu Y, Zhu G, Jiang Y, Wang X, Chen Y, Meng F, Zhang K, Yang A, Liu H, Zhang X, Zhang J (2019) Comparison of short-term stimulation of the globus pallidus interna and subthalamic nucleus for treatment of primary dystonia. World Neurosurg 123:e211–e217. https://doi.org/10.1016/j.wneu.2018.11.137 CrossRefPubMed

27.

Hung SW, Hamani C, Lozano AM, Poon YY, Piboolnurak P, Miyasaki JM, Lang AE, Dostrovsky JO, Hutchison WD, Moro E (2007) Long-term outcome of bilateral pallidal deep brain stimulation for primary cervical dystonia. Neurology 68(6):457–459. https://doi.org/10.1212/01.wnl.0000252932.71306.89 CrossRefPubMed

28.

Coubes P, Cif L, El Fertit H, Hemm S, Vayssiere N, Serrat S, Picot MC, Tuffery S, Claustres M, Echenne B, Frerebeau P (2004) Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results. J Neurosurg 101(2):189–194. https://doi.org/10.3171/jns.2004.101.2.0189 CrossRefPubMed

29.

Kupsch A, Benecke R, Müller J, Trottenberg T, Schneider G-H, Poewe W, Eisner W, Wolters A, Müller J-U, Deuschl G, Pinsker MO, Skogseid IM, Roeste GK, Vollmer-Haase J, Brentrup A, Krause M, Tronnier V, Schnitzler A, Voges J, Nikkhah G, Vesper J, Naumann M, Volkmann J (2006) Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 355:1978–1990CrossRefPubMed

30.

Valldeoriola F, Regidor I, Minguez-Castellanos A, Lezcano E, Garcia-Ruiz P, Rojo A, Salvador A, Castro A, Grandas F, Kulisevsky J, Marti MJ, Martinez-Martin P, Relova L, Rumia J, Camara A, Burguera JA, Linazasoro G, de Val JL, Obeso J, Rodriguez-Oroz MC, Tolosa E (2010) Efficacy and safety of pallidal stimulation in primary dystonia: results of the Spanish multicentric study. J Neurol Neurosurg Psychiatry 81(1):65–69. https://doi.org/10.1136/jnnp.2009.174342 CrossRefPubMed

31.

Isaias IU, Volkmann J, Kupsch A, Burgunder JM, Ostrem JL, Alterman RL, Mehdorn HM, Schonecker T, Krauss JK, Starr P, Reese R, Kuhn AA, Schupbach WM, Tagliati M (2011) Factors predicting protracted improvement after pallidal DBS for primary dystonia: the role of age and disease duration. J Neurol 258(8):1469–1476. https://doi.org/10.1007/s00415-011-5961-9 CrossRefPubMed

32.

Isaias IU, Alterman RL, Tagliati M (2008) Outcome predictors of pallidal stimulation in patients with primary dystonia: the role of disease duration. Brain 131(Pt 7):1895–1902. https://doi.org/10.1093/brain/awn120 CrossRefPubMed

33.

Oxford Centre for Evidence-based Medicine—Levels of Evidence (March 2009). CEBM. (2009) https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed 2 July 2019

34.

McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, Clifford T, Cohen JF, Deeks JJ, Gatsonis C, Hooft L, Hunt HA, Hyde CJ, Korevaar DA, Leeflang MMG, Macaskill P, Reitsma JB, Rodin R, Rutjes AWS, Salameh JP, Stevens A, Takwoingi Y, Tonelli M, Weeks L, Whiting P, Willis BH (2018) Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA 319(4):388–396. https://doi.org/10.1001/jama.2017.19163 CrossRefPubMed

35.

Boyce MJ, Canning CG, Mahant N, Morris J, Latimer J, Fung VS (2012) The Toronto Western Spasmodic Torticollis Rating Scale: reliability in neurologists and physiotherapists. Parkinsonism Relat Disord 18(5):635–637. https://doi.org/10.1016/j.parkreldis.2012.02.007 CrossRefPubMed

36.

Skogseid IM, Kerty E (2005) The course of cervical dystonia and patient satisfaction with long-term botulinum toxin A treatment. Eur J Neurol 12(3):163–170. https://doi.org/10.1111/j.1468-1331.2004.01053.x CrossRefPubMed

37.

Volkmann J, Mueller J, Deuschl G, Kuhn AA, Krauss JK, Poewe W, Timmermann L, Falk D, Kupsch A, Kivi A, Schneider GH, Schnitzler A, Sudmeyer M, Voges J, Wolters A, Wittstock M, Muller JU, Hering S, Eisner W, Vesper J, Prokop T, Pinsker M, Schrader C, Kloss M, Kiening K, Boetzel K, Mehrkens J, Skogseid IM, Ramm-Pettersen J, Kemmler G, Bhatia KP, Vitek JL, Benecke R (2014) Pallidal neurostimulation in patients with medication-refractory cervical dystonia: a randomised, sham-controlled trial. Lancet Neurol 13(9):875–884. https://doi.org/10.1016/s1474-4422(14)70143-7 CrossRefPubMed

38.

Walsh RA, Sidiropoulos C, Lozano AM, Hodaie M, Poon YY, Fallis M, Moro E (2013) Bilateral pallidal stimulation in cervical dystonia: blinded evidence of benefit beyond 5 years. Brain 136(Pt 3):761–769. https://doi.org/10.1093/brain/awt009 CrossRefPubMed

39.

Filip P, Gallea C, Lehéricy S, Bertasi E, Popa T, Mareček R, Lungu OV, Kašpárek T, Vaníček J, Bareš M (2017) Disruption in cerebellar and basal ganglia networks during a visuospatial task in cervical dystonia. Mov Disord 32(5):757–768. https://doi.org/10.1002/mds.26930 CrossRefPubMed

40.

Vidailhet M, Grabli D, Roze E (2009) Pathophysiology of dystonia. Curr Opin Neurol 22(4):406–413. https://doi.org/10.1097/WCO.0b013e32832d9ef3 CrossRefPubMed

41.

Fletcher NA, Stell R, Harding AE, Marsden CD (1988) Degenerative cerebellar ataxia and focal dystonia. Mov Disord 3(4):336–342. https://doi.org/10.1002/mds.870030410 CrossRefPubMed

42.

Filip P, Gallea C, Lehericy S, Bertasi E, Popa T, Marecek R, Lungu OV, Kasparek T, Vanicek J, Bares M (2017) Disruption in cerebellar and basal ganglia networks during a visuospatial task in cervical dystonia. Mov Disord 32(5):757–768. https://doi.org/10.1002/mds.26930 CrossRefPubMed

43.

McIlwain H (1956) Electrical influences and speed of chemical change in the brain. Physiol Rev 36(3):355–375. https://doi.org/10.1152/physrev.1956.36.3.355 CrossRefPubMed

44.

Ashkan K, Rogers P, Bergman H, Ughratdar I (2017) Insights into the mechanisms of deep brain stimulation. Nat Rev Neurol 13:548. https://doi.org/10.1038/nrneurol.2017.105 CrossRefPubMed

45.

Ma X, Suga N (2007) Multiparametric corticofugal modulation of collicular duration-tuned neurons: modulation in the amplitude domain. J Neurophysiol 97(5):3722–3730. https://doi.org/10.1152/jn.01268.2006 CrossRefPubMed

46.

Patil PG, Carmena JM, Nicolelis MAL, Turner DA (2004) Ensemble recordings of human subcortical neurons as a source of motor control signals for a brain-machine interface. Neurosurgery 55(1):27–38. https://doi.org/10.1227/01.NEU.0000126872.23715.E5 CrossRefPubMed

47.

Quartarone A, Cacciola A, Milardi D, Ghilardi MF, Calamuneri A, Chillemi G, Anastasi G, Rothwell J (2019) New insights into cortico-basal-cerebellar connectome: clinical and physiological considerations. Brain. https://doi.org/10.1093/brain/awz310 CrossRef

48.

Ruge D, Cif L, Limousin P, Gonzalez V, Vasques X, Hariz MI, Coubes P, Rothwell JC (2011) Shaping reversibility? Long-term deep brain stimulation in dystonia: the relationship between effects on electrophysiology and clinical symptoms. Brain 134(7):2106–2115. https://doi.org/10.1093/brain/awr122 CrossRefPubMed

49.

Adler CH, Kumar R (2000) Pharmacological and surgical options for the treatment of cervical dystonia. Neurology 55(12 Suppl 5):S9–14PubMed

50.

Diamond A, Shahed J, Azher S, Dat-Vuong K, Jankovic J (2006) Globus pallidus deep brain stimulation in dystonia. Mov Disord 21(5):692–695. https://doi.org/10.1002/mds.20767 CrossRefPubMed

51.

Witt JL, Moro E, Ash RS, Hamani C, Starr PA, Lozano AM, Hodaie M, Poon YY, Markun LC, Ostrem JL (2013) Predictive factors of outcome in primary cervical dystonia following pallidal deep brain stimulation. Mov Disord 28(10):1451–1455. https://doi.org/10.1002/mds.25560 CrossRefPubMed

52.

Kroneberg D, Plettig P, Schneider GH, Kühn AA (2018) Motor cortical plasticity relates to symptom severity and clinical benefit from deep brain stimulation in cervical dystonia. Neuromodulation 21(8):735–740. https://doi.org/10.1111/ner.12690 CrossRefPubMed

53.

Doldersum E, van Zijl JC, Beudel M, Eggink H, Brandsma R, Pina-Fuentes D, van Egmond ME, Oterdoom DLM, van Dijk JMC, Elting JWJ, Tijssen MAJ (2019) Intermuscular coherence as biomarker for pallidal deep brain stimulation efficacy in dystonia. Clin Neurophysiol 130(8):1351–1357. https://doi.org/10.1016/j.clinph.2019.04.717 CrossRefPubMed

54.

Wang X, Zhang Z, Mao Z, Yu X (2019) Deep brain stimulation for Meige syndrome: a meta-analysis with individual patient data. J Neurol 11:2646–2656. https://doi.org/10.1007/s00415-019-09462-2 CrossRef

55.

Shen K-Z, Zhu Z-T, Munhall A, Johnson SW (2003) Synaptic plasticity in rat subthalamic nucleus induced by high-frequency stimulation. Synapse 50(4):314–319. https://doi.org/10.1002/syn.10274 CrossRefPubMed

56.

Coubes P, Roubertie A, Vayssiere N, Hemm S, Echenne B (2000) Treatment of DYT1-generalised dystonia by stimulation of the internal globus pallidus. Lancet 355(9222):2220–2221. https://doi.org/10.1016/s0140-6736(00)02410-7 CrossRefPubMed

57.

Carecchio M, Invernizzi F, Gonzalez-Latapi P, Panteghini C, Zorzi G, Romito L, Leuzzi V, Galosi S, Reale C, Zibordi F, Joseph AP, Topf M, Piano C, Bentivoglio AR, Girotti F, Morana P, Morana B, Kurian MA, Garavaglia B, Mencacci NE, Lubbe SJ, Nardocci N (2019) Frequency and phenotypic spectrum of KMT2B dystonia in childhood: a single-center cohort study. Mov Disord 34(10):1516–1527. https://doi.org/10.1002/mds.27771 CrossRefPubMed

58.

Meyer E, Carss KJ, Rankin J, Nichols JM, Grozeva D, Joseph AP, Mencacci NE, Papandreou A, Ng J, Barral S, Ngoh A, Ben-Pazi H, Willemsen MA, Arkadir D, Barnicoat A, Bergman H, Bhate S, Boys A, Darin N, Foulds N, Gutowski N, Hills A, Houlden H, Hurst JA, Israel Z, Kaminska M, Limousin P, Lumsden D, McKee S, Misra S, Mohammed SS, Nakou V, Nicolai J, Nilsson M, Pall H, Peall KJ, Peters GB, Prabhakar P, Reuter MS, Rump P, Segel R, Sinnema M, Smith M, Turnpenny P, White SM, Wieczorek D, Wiethoff S, Wilson BT, Winter G, Wragg C, Pope S, Heales SJ, Morrogh D, Pittman A, Carr LJ, Perez-Duenas B, Lin JP, Reis A, Gahl WA, Toro C, Bhatia KP, Wood NW, Kamsteeg EJ, Chong WK, Gissen P, Topf M, Dale RC, Chubb JR, Raymond FL, Kurian MA (2017) Mutations in the histone methyltransferase gene KMT2B cause complex early-onset dystonia. Nat Genet 49(2):223–237. https://doi.org/10.1038/ng.3740 CrossRefPubMed

59.

Fahn S (1984) The varied clinical expressions of dystonia. Neurol Clin 2(3):541–554CrossRefPubMed

60.

Fahn S, Marsden CD, Calne DB (1987) Classification and investigation of dystonia. In: Marsden CD, Fahn S (eds) Movement disorders 2. Butterworths, London, pp 332–358

61.

Giri S, Naiya T, Equbal Z, Sankhla CS, Das SK, Ray K, Ray J (2017) Genetic screening of THAP1 in primary dystonia patients of India. Neurosci Lett 637:31–37. https://doi.org/10.1016/j.neulet.2016.11.060 CrossRefPubMed

62.

Vulinovic F, Schaake S, Domingo A, Kumar KR, Defazio G, Mir P, Simonyan K, Ozelius LJ, Bruggemann N, Chung SJ, Rakovic A, Lohmann K, Klein C (2017) Screening study of TUBB4A in isolated dystonia. Parkinsonism Relat Disord 41:118–120. https://doi.org/10.1016/j.parkreldis.2017.06.001Functional CrossRefPubMedPubMedCentral

63.

Hebert E, Borngraber F, Schmidt A, Rakovic A, Braenne I, Weissbach A, Hampf J, Vollstedt EJ, Grosser L, Schaake S, Muller M, Manzoor H, Jabusch HC, Alvarez-Fischer D, Kasten M, Kostic VS, Gasser T, Zeuner KE, Kim HJ, Jeon B, Bauer P, Altenmuller E, Klein C, Lohmann K (2017) Functional characterization of rare RAB12 variants and their role in musician’s and other dystonias. Genes. https://doi.org/10.3390/genes8100276 CrossRefPubMedPubMedCentral

64.

Rossi M, Medina Escobar A, Ameghino L, Merello M (2017) Expanding the phenotype of phosphomannomutase-2 gene congenital disorder of glycosylation: cervical dystonia. J Neurol Sci 378:52–54. https://doi.org/10.1016/j.jns.2017.04.037 CrossRefPubMed

Title: Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis
Authors: Xing Hua
Bohan Zhang
Zhicheng Zheng
Houyou Fan
Linfeng Luo
Xiaosi Chen
Jian Duan
Dongwei Zhou
Meihua Li
Tao Hong
Guohui Lu
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Torticollis Spasticus
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/s00415-020-09765-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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