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

AbstractBackgroundDeep 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.ObjectiveTo identify stimulated brain regions associated with the most beneficial clinical outcome in dystonia patients.Methods18 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.ResultsVTAs 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 intermediat e and non-responders covered the GPi to a significantly larger extent in the left hemisphere (p 
Source: Journal of Neurology - Category: Neurology Source Type: research

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ConclusionsCAP ‐CT myelography with 2D/3D reconstructions is an essential step in the diagnostic algorithm for cases involving ITDD failure.
Source: Neuromodulation: Technology at the Neural Interface - Category: Biotechnology Authors: Tags: Case Series Source Type: research
This study showed that bilateral STN DBS results in a very significant improvement in cervical dystonia with no mental worsening and suggests that STN DBS may be an alternative to GPi DBS for treating primary cervical dystonia.
Source: Acta Neurochirurgica - Category: Neurosurgery Source Type: research
We report a case of idiopathic cervical dystonia that was treated by computed tomography–guided injection of botulinum toxin into multiple deep muscles. Based on clinical presentation of combined torticollis and retrocollis, and needle electromyography results, botulinum toxin was injected under electromyography guidance. This treatment resulted in no improvement. Subsequently, target muscles were identified using 18F-fludeoxyglucose fusion positron emission tomography/computed tomography. botulinum toxin was injected into the hypermetabolic muscles guided by computed tomography. This injection successfully relieved ...
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Case Report Source Type: research
AbstractSCA48 is a novel spinocerebellar ataxia (SCA) originally and recently characterized by prominent cerebellar cognitive-affective syndrome (CCAS) and late-onset ataxia caused by mutations on theSTUB1 gene. Here, we report the first SCA48 case from Turkey with novel clinical features and diffusion tensor imaging (DTI) findings, used for the first time to evaluate a SCA48 patient. A 65-year-old female patient with slowly progressive cerebellar ataxia, cognitive impairment, behavioral changes, and a vertical family history was evaluated. Following the exclusion of repeat expansion ataxias, whole exome sequencing (WES) w...
Source: Neurogenetics - Category: Genetics & Stem Cells Source Type: research
This study aimed to evaluate the usefulness of [99mTc]sestamibi ([99mTc]MIBI) single photon emission computed tomography (SPECT)/X-ray computed tomography (CT) imaging for the identification of dystonic muscles in primary cervical dystonia (PCD) patients who underwent botulinum neurotoxin type A (BoNT-A) therapy.ProceduresThirty-six patients with PCD and 10 healthy subjects (control group) who underwent [99mTc]MIBI SPECT/CT were enrolled. The image characteristics of dystonic muscles and normal muscles were evaluated. Muscle/background ratio (MBR) of six representative muscles was calculated for dystonic muscles in PCD gro...
Source: Molecular Imaging and Biology - Category: Molecular Biology Source Type: research
Conclusions: Our study describes the clinical phenomenology of patients with PTMDs and its radiological correlation. Tremor (alone or in combination with dystonia) was the most common MD observed and diffuse white matter lesions without affection of the basal ganglia was the most common site of lesion.
Source: Neurology India - Category: Neurology Authors: Source Type: research
We report the clinical case of a 49-year-old male with a history of thyroidectomy, who was admitted in Emergency Service with acute generalized chorea and focal painful feet dystonia. Laboratory analysis showed hypocalcemia and rhabdomyolysis, and computed tomography scan revealed parenchymal calcification with basal ganglia involvement. After complementary studies we established a Fahr's Syndrome diagnosis secondary to an iatrogenic hypoparathyroidism. Clinical management has been successful with stabilized calcium levels, with no more neurologic symptoms. Hypocalcemia should be readily investigated and treated after a th...
Source: Acta Medica Portuguesa - Category: General Medicine Tags: Acta Med Port Source Type: research
This study was approved by the Animal Experimental Ethics Committee of Southern Medical University, Guangzhou, China (2014-024). All experiments were performed under protocols to meet the requirements of the Association for Assessment and Accreditation of Laboratory Animal Care International and the Experimental Animal Center of Southern Medical University. Male cynomolgus monkeys (Macaca fascicularis) were used, preliminary power analysis being performed to get the proper sample size for three groups (G∗Power 3.1, Heinrich-Heine-Universität Düsseldorf, Germany; alpha = 0.05, power = 0.95; total N = 20 hem...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
Conclusion: This unusual presentation of a common procedure illustrates a neurological emergency that requires prompt recognition and timely correction. PMID: 30294497 [PubMed]
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research
Conclusion DBS in MTS may be a viable option to treat debilitating dystonic symptoms. We describe successful DBS surgery, despite the presence of bilateral CIs, and stimulation therapy over 2 years. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: Journal of Neurological Surgery Part A: Central European Neurosurgery - Category: Neurosurgery Authors: Tags: Surgical Technique Source Type: research
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