Outcomes of Unilateral Pallidotomy in Focal and Hemidystonia Cases: A Single-Blind Cohort Study.
hemidystonia
lesioning
pallidotomy
Journal
Movement disorders clinical practice
ISSN: 2330-1619
Titre abrégé: Mov Disord Clin Pract
Pays: United States
ID NLM: 101630279
Informations de publication
Date de publication:
Jan 2024
Jan 2024
Historique:
revised:
08
10
2023
received:
19
05
2023
accepted:
10
10
2023
medline:
31
1
2024
pubmed:
31
1
2024
entrez:
31
1
2024
Statut:
ppublish
Résumé
The role of deep brain stimulation in the treatment of dystonia has been widely documented. However, there is limited literature on the outcome of lesioning surgery in unilateral dystonia. We restrospectively reviewed our cases of focal and hemidystonia undergoing unilateral Pallidotomy at our institute to evaluate the short-term and long-term outcome. Patients who underwent radiofrequency lesioning of GPi for unilateral dystonia between 1999 and 2019 were retrospectively reviewed. All patients were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Dystonia Disability Scale (DDS) preoperatively at the short term follow-up (<1 year) and at long-term follow-up (2-7.5 years). Video recordings performed at these time points were independently reviewed by a blinded movement disorders specialist. Eleven patients were included for analysis. The preoperative, short-term, and long-term follow-up motor BFMDRS and DDS scores were 15.5 (IQR [interquartile range]: 10.5, 23.75) and 10.5 (IQR: 6.0, 14.5); 3.0 (IQR: 1.0, 6.0, P = 0.02) and 3.0 (IQR: 3.0, 8.0, P = 0.016); and 14.25 (IQR: 4.0, 20.0, P = 0.20) and 10.5 (IQR: 2.0, 15.0, P = 0.71) respectively. For observers B, the BFMDRS scores at the same time points were 19 (IQR: 12.5, 27.0), 7.5 (IQR: 6.0, 15.0, P = 0.002), and 21 (IQR: 7.0, 22.0, P = 0.65) respectively. The improvement was statistically significant for all observations at short-term follow-up but not at long-term follow-up. Pallidotomy is effective for hemidystonia or focal dystonia in the short term. Continued benefit was seen in the longer term in some patients, whereas others worsened. Larger studies may be able to explain this in future.
Sections du résumé
BACKGROUND
BACKGROUND
The role of deep brain stimulation in the treatment of dystonia has been widely documented. However, there is limited literature on the outcome of lesioning surgery in unilateral dystonia.
OBJECTIVE
OBJECTIVE
We restrospectively reviewed our cases of focal and hemidystonia undergoing unilateral Pallidotomy at our institute to evaluate the short-term and long-term outcome.
METHODS
METHODS
Patients who underwent radiofrequency lesioning of GPi for unilateral dystonia between 1999 and 2019 were retrospectively reviewed. All patients were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Dystonia Disability Scale (DDS) preoperatively at the short term follow-up (<1 year) and at long-term follow-up (2-7.5 years). Video recordings performed at these time points were independently reviewed by a blinded movement disorders specialist.
RESULTS
RESULTS
Eleven patients were included for analysis. The preoperative, short-term, and long-term follow-up motor BFMDRS and DDS scores were 15.5 (IQR [interquartile range]: 10.5, 23.75) and 10.5 (IQR: 6.0, 14.5); 3.0 (IQR: 1.0, 6.0, P = 0.02) and 3.0 (IQR: 3.0, 8.0, P = 0.016); and 14.25 (IQR: 4.0, 20.0, P = 0.20) and 10.5 (IQR: 2.0, 15.0, P = 0.71) respectively. For observers B, the BFMDRS scores at the same time points were 19 (IQR: 12.5, 27.0), 7.5 (IQR: 6.0, 15.0, P = 0.002), and 21 (IQR: 7.0, 22.0, P = 0.65) respectively. The improvement was statistically significant for all observations at short-term follow-up but not at long-term follow-up.
CONCLUSION
CONCLUSIONS
Pallidotomy is effective for hemidystonia or focal dystonia in the short term. Continued benefit was seen in the longer term in some patients, whereas others worsened. Larger studies may be able to explain this in future.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
30-37Informations de copyright
© 2023 International Parkinson and Movement Disorder Society.
Références
Fahn S. Concept and classification of dystonia. Adv Neurol 1988;50:1-8.
Centen LM, Oterdoom DLM, Tijssen MAJ, Lesman-Leegte I, van Egmond ME, van Dijk JMC. Bilateral pallidotomy for dystonia: a systematic review. Mov Disord 2021;36:547-557. https://doi.org/10.1002/mds.28384.
Cooper IS. 20-year followup study of the neurosurgical treatment of dystonia musculorum deformans. Adv Neurol 1976;14:423-452.
Andrew J, Fowler CJ, Harrison MJ. Stereotaxic thalamotomy in 55 cases of dystonia. Brain 1983;106(Pt 4):981-1000.
Alkhani A, Bohlega S. Unilateral pallidotomy for hemidystonia. Mov Disord 2006;21:852-855. https://doi.org/10.1002/mds.20838.
Yoshor D, Hamilton WJ, Ondo W, Jankovic J, Grossman RG. Comparison of thalamotomy and pallidotomy for the treatment of dystonia. Neurosurgery 2001;48:818-824; discussion 824-826. https://doi.org/10.1097/00006123-200104000-00025.
Cardoso F, Jankovic J, Grossman RG, Hamilton WJ. Outcome after stereotactic thalamotomy for dystonia and hemiballismus. Neurosurgery 1995;36:501-507; discussion 507-508. https://doi.org/10.1227/00006123-199503000-00009.
Bertrand C, Molina-Negro P, Martinez SN. Stereotactic targets for dystonias and dyskinesias: relationship to corticobulbar fibers and other adjoining structures. Adv Neurol 1979;24:395-399.
Hariz MI, De Salles AA. The side-effects and complications of posteroventral pallidotomy. Acta Neurochir Suppl 1997;68:42-48. https://doi.org/10.1007/978-3-7091-6513-3_8.
Krack P, Vercueil L. Review of the functional surgical treatment of dystonia. Eur J Neurol 2001;8:389-399.
Richardson RR. Rehabilitative neurosurgery: posttraumatic syndromes. Stereotact Funct Neurosurg 1989;53:105-112. https://doi.org/10.1159/000099525.
Krauss JK, Mohadjer M, Braus DF, Wakhloo AK, Nobbe F, Mundinger F. Dystonia following head trauma: a report of nine patients and review of the literature. Mov Disord 1992;7:263-272. https://doi.org/10.1002/mds.870070313.
Iacono RP, Kuniyoshi SM, Lonser RR, Maeda G, Inae AM, Ashwal S. Simultaneous bilateral pallidoansotomy for idiopathic dystonia musculorum deformans. Pediatr Neurol 1996;14:145-148. https://doi.org/10.1016/0887-8994(96)00003-3.
Krauss JK, Desaloms JM, Lai EC, King DE, Jankovic J, Grossman RG. Microelectrode-guided posteroventral pallidotomy for treatment of Parkinson's disease: postoperative magnetic resonance imaging analysis. J Neurosurg 1997;87:358-367. https://doi.org/10.3171/jns.1997.87.3.0358.
Burke RE, Fahn S, Marsden CD, Bressman SB, Moskowitz C, Friedman J. Validity and reliability of a rating scale for the primary torsion dystonias. Neurology 1985;35:73-77. https://doi.org/10.1212/wnl.35.1.73.
Doshi PK, Ramdasi RV, Karkera B, Kadlas DB. Surgical interventions for task-specific dystonia (Writer's dystonia). Ann Indian Acad Neurol 2017;20:324-327. https://doi.org/10.4103/aian.AIAN_15_17.
Valálik I, Jobbágy A, Bognár L, Csókay A. Effectiveness of unilateral pallidotomy for meige syndrome confirmed by motion analysis. Stereotact Funct Neurosurg 2011;89:157-161. https://doi.org/10.1159/000323341.
Tripathi M, Sharan S, Mehta S, et al. Gamma knife Radiosurgical pallidotomy for dystonia: not a fallen angel. Neurol India 2019;67:1515-1518. https://doi.org/10.4103/0028-3886.273644.
Lin JJ, Lin SZ, Chang DC. Pallidotomy and generalized dystonia. Mov Disord 1999;14:1057-1059. https://doi.org/10.1002/1531-8257(199911)14:6<1057::aid-mds1034>3.0.co;2-1.
Gross RE. What happened to posteroventral pallidotomy for Parkinson's disease and dystonia? Neurotherapeutics 2008;5:281-293. https://doi.org/10.1016/j.nurt.2008.02.001.
Horisawa S, Fukui A, Takeda N, Kawamata T, Taira T. Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia. Ann Clin Transl Neurol 2021;8:857-865. https://doi.org/10.1002/acn3.51333.
Eltahawy HA, Saint-Cyr J, Giladi N, Lang AE, Lozano AM. Primary dystonia is more responsive than secondary dystonia to pallidal interventions: outcome after pallidotomy or pallidal deep brain stimulation. Neurosurgery 2004;54:613-619; discussion 619-621. https://doi.org/10.1227/01.neu.0000108643.94730.21.
Ondo WG, Desaloms JM, Jankovic J, et al. Pallidotomy for generalized dystonia. Mov Disord 1998;13:693-698. https://doi.org/10.1002/mds.870130415.
Loher TJ, Hasdemir MG, Burgunder JM, Krauss JK. Long-term follow-up study of chronic globus pallidus internus stimulation for posttraumatic hemidystonia. J Neurosurg 2000;92:457-460. https://doi.org/10.3171/jns.2000.92.3.0457.
Dallapiazza RF, Lee DJ, Vloo PD, et al. Outcomes from stereotactic surgery for essential tremor. J Neurol Neurosurg Psychiatry 2019;90:474-482. https://doi.org/10.1136/jnnp-2018-318240.
Chuang C, Fahn S, Frucht SJ. The natural history and treatment of acquired hemidystonia: report of 33 cases and review of the literature. J Neurol Neurosurg Psychiatry 2002;72:59-67. https://doi.org/10.1136/jnnp.72.1.59.
Lee MS, Rinne JO, Ceballos-Baumann A, Thompson PD, Marsden CD. Dystonia after head trauma. Neurology 1994;44:1374-1378. https://doi.org/10.1212/wnl.44.8.1374.
Lim JY, De Salles AAF. Sequential postoperative appearance of radiofrequency pallidotomy lesions on MRI. Stereotact Funct Neurosurg 1997;69:46-53. https://doi.org/10.1159/000099851.
Cohn MC, Hudgins PA, Sheppard SK, et al. Pre- and postoperative MR evaluation of stereotactic pallidotomy. AJNR Am J Neuroradiol 1998;19:1075-1080.