Unilateral pallidal deep brain stimulation in a patient with cervical dystonia and tremor

Case report

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Bilateral deep brain stimulation of the globus pallidus pars interna (GPi) is the favored neuromodulation procedure in cases of cervical dystonia. The authors report on a case of unilateral GPi implantation that resulted in sustained benefit with marked improvement in pain and dystonia.

Abbreviations used in this paper: BTX = botulinum toxin; CD = cervical dystonia; DBS = deep brain stimulation; GPi = globus pallidus internus; SCM = sternocleidomastoid; TWSTRS = Toronto Western Spasmodic Torticollis Rating Scale.

Article Information

Address correspondence to: Mojgan Hodaie, M.D., M.Sc., F.R.C.S.C., Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, 4W-443, Toronto, Ontario M5T 2S8, Canada. email: mojgan.hodaie@uhn.on.ca.

Please include this information when citing this paper: published online May 28, 2010; DOI: 10.3171/2010.4.JNS091722.

© AANS, except where prohibited by US copyright law.



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    Postoperative axial T1-weighted (A) and coronal T2-weighted (B) MR images showing the electrode in the lateral GPi.



Albanese ABarnes MPBhatia KPFernandez-Alvarez EFilippini GGasser T: A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task Force. Eur J Neurol 13:4334442006


Bereznai BSteude USeelos KBötzel K: Chronic high-frequency globus pallidus internus stimulation in different types of dystonia: a clinical, video, and MRI report of six patients presenting with segmental, cervical, and generalized dystonia. Mov Disord 17:1381442002


Bittar RGYianni JWang SLiu XNandi DJoint C: Deep brain stimulation for generalised dystonia and spasmodic torticollis. J Clin Neurosci 12:12162005


Bronstein JMDeSalles ADeLong MR: Stereotactic pallidotomy in the treatment of Parkinson disease: an expert opinion. Arch Neurol 56:106410691999


Cersosimo MGRaina GBPiedimonte FAntico JGraff PMicheli FE: Pallidal surgery for the treatment of primary generalized dystonia: long-term follow-up. Clin Neurol Neurosurg 110:1451502008


Chang JWChoi JYLee BWKang UJChung SS: Unilateral globus pallidus internus stimulation improves delayed onset post-traumatic cervical dystonia with an ipsilateral focal basal ganglia lesion. J Neurol Neurosurg Psychiatry 73:5885902002


Collins KLLehmann EMPatil PG: Deep brain stimulation for movement disorders. Neurobiol Dis [epub ahead of print]2009


DeLong MRWichmann T: Circuits and circuit disorders of the basal ganglia. Arch Neurol 64:20242007


Escamilla-Sevilla FMínguez-Castellanos AArjona-Morón VMartín-Linares JMSánchez-Alvarez JCOrtega-Morenoa A: Unilateral pallidal stimulation for segmental cervical and truncal dystonia: which side?. Mov Disord 17:138313852002


Foote KDSanchez JCOkun MS: Staged deep brain stimulation for refractory craniofacial dystonia with blepharospasm: case report and physiology. Neurosurgery 56:E4152005


Ford B: Pallidotomy for generalized dystonia. Adv Neurol 94:2872992004


Gross RE: What happened to posteroventral pallidotomy for Parkinson's disease and dystonia?. Neurotherapeutics 5:2812932008


Hung SWHamani CLozano AMPoon YYPiboolnurak PMiyasaki JM: Long-term outcome of bilateral pallidal deep brain stimulation for primary cervical dystonia. Neurology 68:4574592007


Intemann PMMasterman DSubramanian IDeSalles ABehnke EFrysinger R: Staged bilateral pallidotomy for treatment of Parkinson disease. J Neurosurg 94:4374442001


Işlekel SZileli MZileli B: Unilateral pallidal stimulation in cervical dystonia. Stereotact Funct Neurosurg 72:2482521999


Krause MFogel WKloss MRasche DVolkmann JTronnier V: Pallidal stimulation for dystonia. Neurosurgery 55:136113702004


Levy RDostrovsky JOLang AESime EHutchison WDLozano AM: Effects of apomorphine on subthalamic nucleus and globus pallidus internus neurons in patients with Parkinson's disease. J Neurophysiol 86:2492602001


Lippitz BEMindus PMeyerson BAKihlström LLindquist C: Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. Neurosurgery 44:4524601999


Loher TJPohle TKrauss JK: Functional stereotactic surgery for treatment of cervical dystonia: review of the experience from the lesional era. Stereotact Funct Neurosurg 82:1132004


Lozano AMAbosch A: Pallidal stimulation for dystonia. Adv Neurol 94:3013082004


Lozano AMEltahawy H: How does DBS work?. Suppl Clin Neurophysiol 57:7337362004


Lozano AMHutchison WD: Microelectrode recordings in the pallidum. Mov Disord 17:Suppl 3S150S1542002


Moro EPiboolnurak PArenovich THung SWPoon YYLozano AM: Pallidal stimulation in cervical dystonia: clinical implications of acute changes in stimulation parameters. Eur J Neurol 16:5065122009


Nakamura KChristine CWStarr PAMarks WJ Jr: Effects of unilateral subthalamic and pallidal deep brain stimulation on fine motor functions in Parkinson's disease. Mov Disord 22:6196262007


Odergren TRimpiläinen IBorg J: Sternocleidomastoid muscle responses to transcranial magnetic stimulation in patients with cervical dystonia. Electroencephalogr Clin Neurophysiol 105:44521997


Ondo WAlmaguer MJankovic JSimpson RK: Thalamic deep brain stimulation: comparison between unilateral and bilateral placement. Arch Neurol 58:2182222001


Ondo WGDesaloms JMJankovic JGrossman RG: Pallidotomy for generalized dystonia. Mov Disord 13:6936981998


Ostrem JLStarr PA: Treatment of dystonia with deep brain stimulation. Neurotherapeutics 5:3203302008


Tanei TKajita YKaneoke YTakebayashi SNakatsubo DWakabayashi T: Staged bilateral deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson's disease. Acta Neurochir (Wien) 151:5895942009


Tang JKMoro EMahant NHutchison WDLang AELozano AM: Neuronal firing rates and patterns in the globus pallidus internus of patients with cervical dystonia differ from those with Parkinson's disease. J Neurophysiol 98:7207292007


Toda HHamani CLozano A: Deep brain stimulation in the treatment of dyskinesia and dystonia. Neurosurg Focus 17:1E22004


Uitti RJWharen REDuffy JRLucas JASchneider SLRippeth JD: Unilateral pallidotomy for Parkinson's disease: speech, motor, and neuropsychological outcome measurements. Parkinsonism Relat Disord 6:1331432000


Yu HNeimat JS: The treatment of movement disorders by deep brain stimulation. Neurotherapeutics 5:26362008


Zabek MSobstyl MKoziara HDzierzecki S: Deep brain stimulation of the right nucleus accumbens in a patient with Tourette syndrome. Case report. Neurol Neurochir Pol 42:5545592008




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