Use of surface electromyography to assess and select patients with idiopathic dystonia for bilateral pallidal stimulation

Shouyan Wang Ph.D.1, Xuguang Liu M.Med., Ph.D.1, John Yianni M.D., M.R.C.S.1, Alex L. Green M.R.C.S.1, Carole Joint R.G.N.1, John F. Stein F.R.C.P.1, Peter G. Bain M.D., F.R.C.P.1, Ralph Gregory M.D., F.R.C.P.1, and Tipu Z. Aziz F.R.C.S.(SN), D.Med.Sci.1
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  • 1 University Laboratory of Physiology, University of Oxford; Oxford Functional Neurosurgery, Department of Neurosurgery, Radcliffe Infirmary, Oxford; The Movement Disorders and Neurostimulation Group, Department of Neuroscience, Charing Cross Hospital, London; and Department of Movement and Balance, Division of Neurosciences and Mental Health, Imperial College London, United Kingdom
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Object

The object of this study was to identify a preoperative physiological index by using surface electromyography (EMG) signals that would correlate with clinical outcome in dystonic patients following bilateral pallidal stimulation.

Methods

In 14 patients with spasmodic torticollis, generalized dystonia, and myoclonic dystonia, surface EMG signals were recorded from the most affected muscle groups. Although the dystonia affected different body segments, the EMG signals in all patients could be decomposed into bursting and sustained components. Subsequently, a ratio of the EMG amplitude was calculated between the two components and then correlated with clinical outcome.

Patients who experienced rapid improvement following bilateral pallidal stimulation had a significantly higher EMG ratio compared with those who did not. Furthermore, a significant correlation was found between the EMG ratio and clinical improvement during the 12-month period following pallidal stimulation.

Conclusions

The authors concluded that surface EMG studies could be used to predict the clinical outcome of and to select patients for pallidal stimulation for dystonia.

Abbreviations used in this paper:

ANOVA = analysis of variance; DBS = deep brain stimulation; EMG = electromyography; GPI = globus pallidus internus; SD = standard deviation; SEM = standard error of the mean.

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Contributor Notes

Address reprint requests to: Xuguang Liu, M.Med., Ph.D., Charing Cross Hospital, 12 East, Fulham Palace Road, London W6 8RF, United Kingdom. email: x.liu@ic.ac.uk.
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