What's new in surgical treatment for dystonia?
Identifieur interne : 000051 ( France/Analysis ); précédent : 000050; suivant : 000052What's new in surgical treatment for dystonia?
Auteurs : Elena Moro [France] ; Robert E. Gross ; Joachim K. KraussSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2013.
English descriptors
- KwdEn :
- MESH :
- methods : Deep Brain Stimulation.
- physiology : Globus Pallidus.
- psychology : Disabled Persons, Dystonia.
- surgery : Globus Pallidus.
- therapy : Dystonia.
- trends : Deep Brain Stimulation.
- Humans, Quality of Life.
Abstract
It is now established that pallidal deep brain stimulation (DBS) is effective in the treatment of generalized and segmental primary dystonia, although there is still insufficient evidence to support its benefit in focal and secondary dystonia. Because several studies have demonstrated that pallidal DBS improves quality of life (QoL), reduced QoL and disability that are nonresponsive to medical treatment are probably the main factors guiding the decision to consider surgery. Some studies have indicated that young patients with primary dystonia who have shorter disease duration and less severe dystonia are likely to have the best outcome from DBS. Therefore, surgery should not be delayed when disability and QoL are impaired to the extent that justifies the surgical risk. A case-by-case approach is recommended in patients who have secondary dystonia. The globus pallidus internus is considered the best target for dystonia. There are still not enough data about the effectiveness of thalamic, subthalamic nucleus, and premotor cortex stimulation. Targeting with multiple electrodes and intra-individual comparisons of outcomes may help determine which target would be more beneficial. With regard to the role of lesions, pallidotomy for dystonia is still performed in several countries and can play a role in selected patients. New technologies are already available to improve the stimulation programming for DBS patients and to increase battery longevity. In the near future, it is possible that we will be able to shape stimulation settings according to disease type and symptoms. © 2013 Movement Disorder Society.
DOI: 10.1002/mds.25550
PubMed: 23893457
Affiliations:
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pubmed:23893457Le document en format XML
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Gross</name></author><author><name sortKey="Krauss, Joachim K" sort="Krauss, Joachim K" uniqKey="Krauss J" first="Joachim K" last="Krauss">Joachim K. 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Gross</name></author><author><name sortKey="Krauss, Joachim K" sort="Krauss, Joachim K" uniqKey="Krauss J" first="Joachim K" last="Krauss">Joachim K. Krauss</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="eISSN">1531-8257</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Deep Brain Stimulation (methods)</term><term>Deep Brain Stimulation (trends)</term><term>Disabled Persons (psychology)</term><term>Dystonia (psychology)</term><term>Dystonia (therapy)</term><term>Globus Pallidus (physiology)</term><term>Globus Pallidus (surgery)</term><term>Humans</term><term>Quality of Life</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Globus Pallidus</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Disabled Persons</term><term>Dystonia</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Globus Pallidus</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Dystonia</term></keywords><keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Deep Brain Stimulation</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term><term>Quality of Life</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">It is now established that pallidal deep brain stimulation (DBS) is effective in the treatment of generalized and segmental primary dystonia, although there is still insufficient evidence to support its benefit in focal and secondary dystonia. Because several studies have demonstrated that pallidal DBS improves quality of life (QoL), reduced QoL and disability that are nonresponsive to medical treatment are probably the main factors guiding the decision to consider surgery. Some studies have indicated that young patients with primary dystonia who have shorter disease duration and less severe dystonia are likely to have the best outcome from DBS. Therefore, surgery should not be delayed when disability and QoL are impaired to the extent that justifies the surgical risk. A case-by-case approach is recommended in patients who have secondary dystonia. The globus pallidus internus is considered the best target for dystonia. There are still not enough data about the effectiveness of thalamic, subthalamic nucleus, and premotor cortex stimulation. Targeting with multiple electrodes and intra-individual comparisons of outcomes may help determine which target would be more beneficial. With regard to the role of lesions, pallidotomy for dystonia is still performed in several countries and can play a role in selected patients. New technologies are already available to improve the stimulation programming for DBS patients and to increase battery longevity. In the near future, it is possible that we will be able to shape stimulation settings according to disease type and symptoms. © 2013 Movement Disorder Society.</div></front></TEI><affiliations><list><country><li>France</li></country><settlement><li>Grenoble</li></settlement></list><tree><noCountry><name sortKey="Gross, Robert E" sort="Gross, Robert E" uniqKey="Gross R" first="Robert E" last="Gross">Robert E. Gross</name><name sortKey="Krauss, Joachim K" sort="Krauss, Joachim K" uniqKey="Krauss J" first="Joachim K" last="Krauss">Joachim K. Krauss</name></noCountry><country name="France"><noRegion><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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