Deep brain stimulation for intractable tardive dystonia: Literature overview

Background Tardive dystonia (TD) represents a side effect of prolonged intake of dopamine receptor blocking compounds. TD can be a disabling movement disorder persisting despite available medical treatment. Deep brain stimulation (DBS) has been reported successful in this condition although the number of treated patients with TD is still limited to small clinical studies or case reports. The aim of this study was to present the systematical overview of the existing literature regarding DBS for intractable TD. Methods and results A literature search was carried out in PudMed. Clinical case series or case reports describing the patients with TD after DBS treatment were included in the present overview. Literature search revealed 19 articles reporting 59 individuals operated for TD. GPi was the target in 55 patients, while subthalamic nucleus (STN) was the target in the remaining 4. In most studies the motor part of Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS) was improved by more than 80% when compared to preoperative BFMDRS scores. Conclusions The performed literature analysis indicates that bilateral GPi DBS is an effective treatment for disabling TD. The response of TD to bilateral GPi DBS may be very rapid and occurs within days/weeks after the procedure. The efficacy of bilateral GPi DBS in TD patients is comparable to results achieved in patients with primary generalized dystonia

Spinal cord stimulation for treatment of complex regional pain syndrome: a single-centre retrospective case series study

Introduction. Complex regional pain syndrome (CRPS) is a debilitating disease with limited available treatment options. Spinal cord stimulation (SCS) is a universal option that promises to improve quality of life by reducing intractable neuropathic pain. The aim of this study was to describe the effectiveness and safety of SCS as a treatment for CRPS patients.Clinical rationale for the study. SCS as an invasive method has relatively recently been introduced to CRPS therapy. We hypothesised that by assessing the effectiveness and safety of SCS, we could justify its early use in the treatment of this debilitating condition.Material and methods. CRPS is a multifactorial and disabling disorder with complex aetiopathogenesis. The primary goals of CRPS treatment include pain relief, functional restoration, and psychological stabilisation. Early intervention is needed to achieve these objectives. In this study, we performed a retrospective evaluation of clinical outcomes in seven patients with severe, intractable CRPS treated by SCS. All patients underwent implantation of a non-rechargeable prime advanced MRI implantable pulse generator (IPG) (Medtronic, Minneapolis, MN, USA) between December 2017 and December 2020 using identical surgical and intraprocedural techniques.Results. From a total of 21 patients treated with SCS over the three years in question, seven (33%) were diagnosed with severe CRPS. The duration of chronic pain ranged between two and 12 years. In six cases (86%), an electrode was implanted in the thoracic segment. Good (partial pain reduction) or very good (complete pain relief) treatment results were observed in five patients (72%). In two cases (28%), two revision surgeries were performed for wound debridement. These hardware-related complications were primarily related to erosions located over implanted IPG’s.Conclusions and clinical implications. SCS is the best alternative for patients with CRPS. It should be used immediately after the failure of conservative treatment. Despite the relatively high complication rate in our series, it is the best choice for pain reduction management in this select group of patients

Stereotaktyczna radiochirurgia w leczeniu chorób ruchu

Neurochirurgia czynnościowa jest współcześnie uznaną metodą leczenia takich chorób ruchu, jak choroba Parkinsona, drżenie samoistne i dystonia. Skuteczność i bezpieczeństwo głębokiej stymulacji mózgu przyczyniły się do stopniowego wyparcia operacji ablacyjnych w leczeniu chorób ruchu. Stereotaktyczna radiochirurgia z użyciem noża gamma jest nieinwazyjną metodą wykonania celowanego uszkodzenia tkanki mózgu poprzez precyzyjne naprowadzanie wiązek promieniowania gamma na ściśle określony punkt. Głównym ograniczeniem stereotaktycznej radiochirurgii jest brak możliwości elektrofizjologicznego określenia celu stereotaktycznego. Pomimo to pacjenci w zaawansowanym wieku, z licznymi obciążeniami internistycznymi, które stanowią przeciwwskazania do klasycznej otwartej operacji stereotaktycznej, jak również chorzy przyjmujący na stałe leki przeciwkrzepliwe mogą uzyskać znaczną poprawę czynnościową po radiochirurgii stereotaktycznej z użyciem noża gamma

Deep brain stimulation failure due to external cardioversion in a patient with Parkinson's disease

We report a case of deep brain stimulation (DBS) hardware failure due to emergently performed subcutaneous coronary angioplasties complicated by cardioversion for rapid worsening of angina pectoris and some trouble shooting problems emerged after invasive cardiovascular procedures. The patient with prior implantation of permanent pacemaker due to vasovagal syndrome underwent successful left-sided unilateral electrode implantation into the subthalamic nucleus. During 21 months follow-up period the patient experienced 2 times episodes of aggravation of unstable angina pectoris 15 and 21 months respectively, which necessities emergent coronary angioplasties. After the first emergently performed coronary angioplasty with cardioversion the interrogation of DBS system revealed the depletion of an internal pulse generator (IPG). The secondly performed coronary angioplasty complicated by ventricular tachyarrhythmia with DBS system switched on during emergent cardioversion resulted in partial dysfunction of DBS electrode. Patients harboring cardiovascular implantable electronic devices (CIEDs) and DBS systems require special attention and good cooperation of neurosurgeons, interventional cardiologist, and neurologist. Some emergently performed invasive cardiovascular procedures which necessities cardioversion may cause DBS hardware failure with subsequent worsening of movement disorder symptoms

The neurosurgical treatment of patients in dystonic state – Overview of the literature

Treatment options for patients in dystonic state include sedation, artificial ventilation, intrathecal baclofen infusions and stereotactic procedures. The main aim of this overview is the presentation and assessment of stereotactic procedures applied for treating patients in severe dystonic state. We performed literature overview starting from 1998 to 2012 with case reports regarding all patients treated by stereotactic procedures for dystonic state. We were able to find 15 articles describing 22 patients. Ablative procedures were described in 5 articles (3 thalamotomies, 3 pallidotomies) and were done in 6 patients. In the remaining 10 articles, globus pallidus internus stimulation was utilized in another 16 patients. We can conclude that bilateral pallidal deep brain stimulation seems to be the best stereotactic target for patients in dystonic state

Twiddler syndrome in a patient with tremor dominant Parkinson's disease. A case report and literature review

Twiddler syndrome is described as a spontaneous rotation or intentional external manipulation of implanted cardiac or occasionally deep brain stimulation (DBS) devices. We report this hardware related complication in a patient with tremor dominant Parkinson's disease (PD), who underwent unilateral subthalamic nucleus (STN) DBS and subsequently developed twiddler syndrome. The clinical course of twiddler syndrome in this patient is described. Some surgical nuances which may prevent its occurrence are suggested. Our case report indicates that twiddler syndrome occurs in DBS patients. Impedance check of DBS hardware, plain chest X-ray, or palpation for a knobbly extension lead through the skin above the IPG allows the correct diagnosis and subsequently a prompt surgical revision. Our subsequent literature review revealed only 10 patients with twiddler syndrome in DBS patient population worldwide. This number may suggest that this syndrome may be unrecognized or underreported, given the number of patients with movement disorders implanted with DBS hardware worldwide

Przewlekła obustronna stymulacja części wewnętrznych gałek bladych u chorych z dystonią uogólnioną – wielokontaktowa katodalna stymulacja jest skuteczniejsza niż stymulacja bipolarna. Wyniki wstępne

Background and purpose Primary generalized dystonia (PGD) is a medically refractory progressive disease of the brain causing near total handicap of affected patients. The aim of the study was to assess the efficacy and safety of bilateral pallidal stimulation in patients with PGD. Material and methods The study population is composed of 5 patients with PGD. The formal objective assessment included the Burke-Fahn-Marsden dystonia rating scale (BFMDRS). All stereotactic procedures were performed in general anaesthesia using a Leksell G stereotactic head frame without electrophysiological guidance. Immediately after insertion of deep brain stimulation (DBS) leads, the internal pulse generators (Itrel II or Soletra) were implanted subcutaneously in the chest wall or abdominal region. Results There were no complications related to the stereotactic procedures. The hardware-related complications (two broken DBS leads) were replaced successfully. There were no infections or erosions of implanted hardware. It has been observed that in the long-term follow-up period primary set bipolar stimulation mode lost its benefit achieved previously. Various stimulation combinations were investigated. Monopolar cathodal or especially multi-contact cathodal stimulation was the most effective one. The efficacy of bilateral pallidal stimulation was proved by the objective validated BFMDRS at long-term follow-up. Conclusions Response to DBS may improve with the number of activated cathodal contacts within the globus pallidus internus.Wstęp i cel pracy Pierwotna dystonia uogólniona to postępujące, oporne na leczenie farmakologiczne schorzenie, które prowadzi do prawie całkowitego inwalidztwa dotkniętych nim chorych. Celem tej pracy jest ocena skuteczności i bezpieczeństwa obustronnej stymulacji części wewnętrznych gałek bladych u chorych z pierwotną dystonią uogólnioną. Materiał i metody Badaną grupę stanowiło 5 pacjentów. Stopień nasilenia dystonii oceniono obiektywnie w skali Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Wszystkie operacje stereotaktyczne przeprowadzono w znieczuleniu ogólnym z wykorzystaniem ramy stereotaktycznej Leksell G bez śródoperacyjnego badania elektrofizjologicznego. Bezpośrednio po wszczepieniu elektrod do głębokiej stymulacji mózgu, generatory impulsów (Itrel II lub Soletra) wszczepiono podskórnie w okolice klatki piersiowej lub powłoki jamy brzusznej. Wyniki Nie obserwowano powikłań związanych z operacjami stereotaktycznymi. Dwie uszkodzone – przerwane – elektrody do głębokiej stymulacji mózgu wymieniono bez powikłań. Nie stwierdzono zakażeń ani nadżerek wszczepionych elementów do głębokiej stymulacji mózgu. W obserwacji pooperacyjnej zauważono, że stymulacja bipolarna zaczęła tracić swój korzystny efekt widoczny w bezpośrednim okresie pooperacyjnym. U chorych próbowano zastosować różne kombinacje aktywnych kontaktów wszczepionych elektrod. Okazało się, że najskuteczniejsza jest stymulacja katodalna, a szczególnie wielokontaktowa stymulacja katodalna. Skuteczność stymulacji katodalnej potwierdzono w obserwacji długoterminowej na podstawie skali BFMDRS. Wnioski Skuteczność głębokiej stymulacji mózgu może się zwiększać wraz z liczbą aktywnych kontaktów jako katody w zakresie części wewnętrznej gałki bladej

Surgical management of spontaneous intracranial hypotension syndrome: a literature review

Introduction. Spontaneous intracranial hypotension (SIH) is a highly disabling but often misdiagnosed disorder. The optimal management options for patients with SIH remain uncertain. The aim of this study was to review studies reporting the management of SIH with a special emphasis on the surgical treatment of SIH including clinical trials, case series and case reports related to the issue of various neurosurgical procedures performed for SIH treatment. Objective. The clinical outcomes of patients diagnosed with SIH treated with either only surgery or with surgery as the primary method of treatment were analysed. Material and methods. The PubMed, Scopus and Google Scholar databases were searched according to the established criteria. Results. The literature search revealed seven clinical trials, five case series and eight case reports regarding surgical treatment of patients diagnosed with SIH. Manuscripts reporting at least five individuals treated surgically for SIH were considered as case series. In most published articles, surgery provided clinical benefit, resulting in a success rate of 82.6-100% for complete relief of SIH symptoms. Conclusions. Our literature review has revealed that SIH can be diagnosed reliably by MRI and cisternography. The identification of the location of SIH is mandatory for its successful surgical treatment. The clinical outcome is related to the location of SIH in the spinal canal. Most often, cerebrospinal fluid leakage occurs in the thoracic region. Surgical treatment is very effective and the obtained treatment results are complete and permanent. of the location of SIH is mandatory for its successful surgical treatment. The clinical outcome is related to the location of SIH in the spinal canal. Most often, cerebrospinal fluid leakage occurs in the thoracic region. Surgical treatment is very effective and the obtained treatment results are complete and permanent