Alleviation of off-period dystonia in Parkinson disease by a microlesion following subthalamic implantation

Clinical article

Stéphane Derrey M.D.1, Romain Lefaucheur M.D.2, Nathalie Chastan M.D., Ph.D.3, Emmanuel Gérardin M.D., Ph.D.4, Didier Hannequin M.D., Ph.D.2,5, Marie Desbordes M.D.6, and David Maltête M.D., Ph.D.2,5
View More View Less
  • 1 Departments of Neurosurgery,
  • | 2 Neurology,
  • | 3 Laboratory of Neurophysiology, and
  • | 4 Radiology, Rouen University Hospital and University of Rouen;
  • | 5 Inserm U614, Rouen Faculty of Medicine; and
  • | 6 Department of Psychiatry, Rouen University Hospital and University of Rouen, France
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

Object

A collision/implantation or microlesion effect is commonly described after subthalamic nucleus (STN) implantation for high-frequency stimulation, and this is presumed to reflect disruption of cells and/or fibers. Off-period dystonia, a frequent cause of disability in patients with advanced Parkinson disease, can lead to the need for surgical treatment. The authors assessed the early effect of this microlesion on off-period dystonia.

Methods

The authors assessed 30 consecutive patients with the advanced levodopa-responsive form of Parkinson disease. The patients' symptoms were Hoehn and Yahr Scale score ≥ 3, the mean duration of their disease was 11.4 ± 3.5 years, and they had undergone bilateral implantation of electrodes within the STN for high-frequency stimulation between February 2004 and December 2006. The microlesion effect was defined by the clinical improvement (Unified Parkinson's Disease Rating Scale [UPDRS] Part III score, UPDRS Part IV, item 35) assessed the morning of the 3rd day following STN implantation, after at least a 12-hour withdrawal of dopaminergic treatment and before the programmable pulse generator was switched on (off-drug/off-stimulation mode).

Results

Compared with baseline (off state), the microlesion effect improved the motor score (UPDRS Part III) by 27%. Subscores for tremor, rigidity, and bradykinesia respectively improved by 42, 37, and 25%. Nineteen patients (63%) suffered from off-period dystonia before surgery. Twelve (41%) reported complete relief of their symptoms in the immediate postoperative period and remained free of painful off-period dystonia throughout the 6-month follow-up period.

Conclusions

The author postulated that off-period dystonia alleviation may reflect both a microsubthalamotomy and micropallidotomy effect. They hypothesize, moreover, that the microlesion could play a role in the 6-month postoperative outcome.

Abbreviations used in this paper:

GPi = internal globus pallidus; PD = Parkinson disease; STN = subthalamic nucleus; UPDRS = Unified Parkinson's Disease Rating Scale.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Alvarez L, , Macias R, , Guridi J, , Lopez G, , Alvarez E, & Maragoto C, et al.: Dorsal subthalamotomy for Parkinson's disease. Mov Disord 16:7278, 2001

    • Search Google Scholar
    • Export Citation
  • 2

    Benabid AL, , Chabardes S, , Mitrofanis J, & Pollak P: Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson's disease. Lancet Neurol 8:6781, 2009

    • Search Google Scholar
    • Export Citation
  • 3

    Cersosimo MG, , Raina GB, , Benarroch EE, , Piedimonte F, , Alemán GG, & Micheli FE: Micro lesion effect of the globus pallidus internus and outcome with deep brain stimulation in patients with Parkinson disease and dystonia. Mov Disord 24:14881493, 2009

    • Search Google Scholar
    • Export Citation
  • 4

    Chou KL, , Forman MS, , Trojanowski JQ, , Hurtig HI, & Baltuch GH: Subthalamic nucleus deep brain stimulation in a patient with levodopa-responsive multiple system atrophy. Case report. J Neurosurg 100:553556, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Chou KL, , Hurtig HI, , Jaggi JL, & Baltuch GH: Bilateral subthalamic nucleus deep brain stimulation in a patient with cervical dystonia and essential tremor. Mov Disord 20:377380, 2005

    • Search Google Scholar
    • Export Citation
  • 6

    Counelis GJ, , Simuni T, , Forman MS, , Jaggi JL, , Trojanowski JQ, & Baltuch GH: Bilateral subthalamic nucleus deep brain stimulation for advanced PD: correlation of intraoperative MER and postoperative MRI with neuropathological findings. Mov Disord 18:10621065, 2003

    • Search Google Scholar
    • Export Citation
  • 7

    Deuschl G, , Herzog J, , Kleiner-Fisman G, , Kubu C, , Lozano AM, & Lyons KE, et al.: Deep brain stimulation: postoperative issues. Mov Disord 21:14 Suppl S219S237, 2006

    • Search Google Scholar
    • Export Citation
  • 8

    Fabbrini G, , Brotchie JM, , Grandas F, , Nomoto M, & Goetz CG: Levodopa-induced dyskinesias. Mov Disord 22:13791389, 2007

  • 9

    Fahn S, & Elton R, Members of UPDRS Development Committee, Unified Parkinson's disease rating scale. Fahn S, , Marsden C, , Calne D, & Goldstein M: Recent Developments in Parkinson's disease Vol 2:New York, Macmillan, 1987. 153163

    • Search Google Scholar
    • Export Citation
  • 10

    Gill SS, & Heywood P: Bilateral dorsolateral subthalamotomy for advanced Parkinson's disease. Lancet 350:1224, 1997. (Letter)

  • 11

    Granziera C, , Pollo C, , Russmann H, , Staedler C, , Ghika J, & Villemure JG, et al.: Sub-acute delayed failure of subthalamic DBS in Parkinson's disease: the role of micro-lesion effect. Parkinsonism Relat Disord 14:109113, 2008

    • Search Google Scholar
    • Export Citation
  • 12

    Haberler C, , Alesch F, , Mazal PR, , Pilz P, , Jellinger K, & Pinter MM, et al.: No tissue damage by chronic deep brain stimulation in Parkinson's disease. Ann Neurol 48:372376, 2000

    • Search Google Scholar
    • Export Citation
  • 13

    Hashimoto T, , Tada T, , Nakazato F, , Maruyama T, , Katai S, & Izumi Y, et al.: Abnormal activity in the globus pallidus in off-period dystonia. Ann Neurol 49:242245, 2001

    • Search Google Scholar
    • Export Citation
  • 14

    Henderson JM, , Pell M, , O'Sullivan DJ, , McCusker EA, , Fung VSC, & Hedges P, et al.: Postmortem analysis of bilateral subthalamic electrode implants in Parkinson's disease. Mov Disord 17:133137, 2002

    • Search Google Scholar
    • Export Citation
  • 15

    Hilker R, , Voges J, , Weber T, , Kracht LW, , Roggendorf J, & Baudrexel S, et al.: STN-DBS activates the target area in Parkinson disease: an FDG-PET study. Neurology 71:708713, 2008

    • Search Google Scholar
    • Export Citation
  • 16

    Jarraya B, , Bonnet AM, , Duyckaerts C, , Houeto JL, , Cornu P, & Hauw JJ, et al.: Parkinson's disease, subthalamic stimulation, and selection of candidates: a pathological study. Mov Disord 18:15171520, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Kleiner-Fisman G, , Herzog J, , Fisman DN, , Tamma F, , Lyons KE, & Pahwa R, et al.: Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 21:14 Suppl S290S304, 2006

    • Search Google Scholar
    • Export Citation
  • 18

    Koop MM, , Andrzejewski A, , Hill BC, , Heit G, & Bronte-Stewart HM: Improvement in a quantitative measure of bradykinesia after microelectrode recording in patients with Parkinson's disease during deep brain stimulation surgery. Mov Disord 21:673678, 2006

    • Search Google Scholar
    • Export Citation
  • 19

    Krack P, , Fraix V, , Mendes A, , Benabid AL, & Pollak P: Postoperative management of subthalamic nucleus stimulation for Parkinson's disease. Mov Disord 17:3 Suppl 3 S188S197, 2002

    • Search Google Scholar
    • Export Citation
  • 20

    Laitinen LV, , Bergenheim AT, & Hariz MI: Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 76:5361, 1992

    • Search Google Scholar
    • Export Citation
  • 21

    Lang AE, , Lozano AM, , Montgomery E, , Duff J, , Tasker R, & Hutchinson W: Posteroventral medial pallidotomy in advanced Parkinson's disease. N Engl J Med 337:10361042, 1997

    • Search Google Scholar
    • Export Citation
  • 22

    Langston JW, , Widner H, , Goetz CG, , Brooks D, , Fahn S, & Freeman T, et al.: Core assessment program for intracerebral transplantations (CAPIT). Mov Disord 7:213, 1992

    • Search Google Scholar
    • Export Citation
  • 23

    Loher TJ, , Burgunder JM, , Weber S, , Sommerhalder R, & Krauss JK: Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson's disease. J Neurol Neurosurg Psychiatry 73:395399, 2002

    • Search Google Scholar
    • Export Citation
  • 24

    Maltête D, , Chastan N, , Derrey S, , Debono B, , Gérardin E, & Lefaucheur B, et al.: Microsubthalamotomy at day 3: screening for determinants. Mov Disord 24:286289, 2009

    • Search Google Scholar
    • Export Citation
  • 25

    Maltête D, , Derrey S, , Chastan N, , Debono B, , Gérardin E, & Fréger P, et al.: Microsubthalamotomy: an immediate predictor of long-term subthalamic stimulation efficacy in Parkinson disease. Mov Disord 23:10471050, 2008

    • Search Google Scholar
    • Export Citation
  • 26

    Maltête D, , Navarro S, , Welter ML, , Roche S, , Bonnet AM, & Houeto JL, et al.: Subthalamic stimulation in Parkinson disease: with or without anesthesia?. Arch Neurol 61:390392, 2004

    • Search Google Scholar
    • Export Citation
  • 27

    Mann JM, , Foote KD, , Garvan CW, , Fernandez HH, , Jacobson CE IV, & Rodriguez RL, et al.: Brain penetration effects of microelectrodes and DBS leads in STN or Gpi. J Neurol Neurosurg Psychiatry 80:794797, 2009

    • Search Google Scholar
    • Export Citation
  • 28

    McHale DM, , Sage JI, , Sonsalla PK, & Vitagliano D: Complex dystonia of Parkinson's disease: clinical features and relation to plasma levodopa profile. Clin Neuropharmacol 13:164170, 1990

    • Search Google Scholar
    • Export Citation
  • 29

    Melamed E: Early-morning dystonia. A late side effect of long-term levodopa therapy in Parkinson's disease. Arch Neurol 36:308310, 1979

    • Search Google Scholar
    • Export Citation
  • 30

    Moll CKE, , Hamel W, , Ostertag CB, , Müller D, , Finsterbusch J, & Engel AK, et al.: Subthalamotomy in cervical dystonia: a case study of lesion location and clinical outcome. Mov Disord 23:17511756, 2008

    • Search Google Scholar
    • Export Citation
  • 31

    Nielsen MS, , Bjarkam CR, , Sørensen JC, , Bojsen-Møller M, , Sunde NA, & Østergaard K: Chronic subthalamic high-frequency deep brain stimulation in Parkinson's disease—a histopathological study. Eur J Neurol 14:132138, 2007

    • Search Google Scholar
    • Export Citation
  • 32

    Péchevis M, , Clarke CE, , Vieregge P, , Khoshnood B, , Deschaseaux-Voinet C, & Berdeaux G, et al.: Effects of dyskinesias in Parkinson's disease on quality of life and health-related costs: a prospective European study. Eur J Neurol 12:956963, 2005

    • Search Google Scholar
    • Export Citation
  • 33

    Poewe WH, , Lees AJ, & Stern GM: Dystonia in Parkinson's disease: clinical and pharmacological features. Ann Neurol 23:7378, 1988

  • 34

    Pourfar M, , Tang C, , Lin T, , Dhawan V, , Kaplitt MG, & Eidelberg D: Assessing the microlesion effect of subthalamic deep brain stimulation surgery with FDG PET. J Neurosurg 110:12781282, 2009

    • Search Google Scholar
    • Export Citation
  • 35

    Starr PA, , Rau GM, , Davis V, , Marks WJ, , Ostrem JL, & Simmons D, et al.: Spontaneous pallidal neuronal activity in human dystonia: comparison with Parkinson's disease and normal macaque. J Neurophysiol 93:31653176, 2005

    • Search Google Scholar
    • Export Citation
  • 36

    Talmant V, , Esposito P, , Stilhart B, , Mohr M, & Tranchant C: [Subthalamic stimulation in a patient with multiple system atrophy: a clinicopathological report]. Rev Neurol (Paris) 162:363370, 2006. (Fr)

    • Search Google Scholar
    • Export Citation
  • 37

    Vitek JL, , Chockkan V, , Zhang J-Y, , Kaneoke Y, , Evatt M, & De-Long MR, et al.: Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol 46:2235, 1999

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 471 129 2
Full Text Views 107 16 0
PDF Downloads 79 16 0
EPUB Downloads 0 0 0