Shaping reversibility? Long-term deep brain stimulation in dystonia: the relationship between effects on electrophysiology and clinical symptoms
Identifieur interne : 001897 ( Main/Merge ); précédent : 001896; suivant : 001898Shaping reversibility? Long-term deep brain stimulation in dystonia: the relationship between effects on electrophysiology and clinical symptoms
Auteurs : Dian Ruge [Royaume-Uni] ; Laura Cif [France] ; Patricia Limousin [Royaume-Uni] ; Victoria Gonzalez [France] ; Xavier Vasques [France] ; Marwan I. Hariz [Royaume-Uni] ; Philippe Coubes [France] ; John C. Rothwell [Royaume-Uni]Source :
- Brain [ 0006-8950 ] ; 2011.
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- Pascal (Inist)
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Abstract
Long-term results show that benefits from chronic deep brain stimulation in dystonia are maintained for many years. Despite this, the neurophysiological long-term consequences of treatment and their relationship to clinical effects are not well understood. Previous studies have shown that transcranial magnetic stimulation measures of abnormal long-term potentiation-like plasticity (paired associative stimulation) and GABAa-ergic inhibition (short-interval intracortical inhibition), which are seen in dystonia, normalize after several months of deep brain stimulation. In the present study, we examine the same measures in a homogenous group of 10 DYT1 gene-positive patients after long-term deep brain stimulation treatment for at least 4.5 years. Recordings were made 'on' deep brain stimulation and after stopping deep brain stimulation for 2 days. The results show that: (i) on average, prior to discontinuing deep brain stimulation, the paired associative stimulation response was almost absent and short-interval intracortical inhibition was reduced compared with normal. This pattern differs from that in both healthy volunteers and from the typical pattern of enhanced plasticity and reduced inhibition seen in deep brain stimulation-naive dystonia. It is similar to that seen in untreated Parkinson's disease and may relate to thus far unexplained clinical phenomena like parkinsonian symptoms that have sometimes been observed in patients treated with deep brain stimulation. (ii) Overall, there was no change in average physiological or clinical status when deep brain stimulation was turned off for 2 days, suggesting that deep brain stimulation had produced long-term neural reorganization in the motor system. (iii) However, there was considerable variation between patients. Those who had higher levels of plasticity when deep brain stimulation was 'on', had the best retention of clinical benefit when deep brain stimulation was stopped and vice versa. This may indicate that better plasticity is required for longer term retention of normal movement when deep brain stimulation is off. (iv) Patients with the highest plasticity 'on' deep brain stimulation were those who had been receiving stimulation with the least current drain. This suggests that it might be possible to 'shape' deep brain stimulation of an individual patient to maximize beneficial neurophysiological patterns that have an impact on clinical status. The results are relevant for understanding long-term consequences and management of deep brain stimulation in dystonia.
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Long-term deep brain stimulation in dystonia: the relationship between effects on electrophysiology and clinical symptoms</title><author><name sortKey="Ruge, Dian" sort="Ruge, Dian" uniqKey="Ruge D" first="Dian" last="Ruge">Dian Ruge</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London</s1><s2>London WC1N3BG</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Unit of Functional Neurosurgery, Sobell Department, UCL Institute of Neurology</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 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nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Universite de Montpellier 1</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>CNRS UMR5203, Institut de Genomique Fonctionnelle</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation></author><author><name sortKey="Vasques, Xavier" sort="Vasques, Xavier" uniqKey="Vasques X" first="Xavier" last="Vasques">Xavier Vasques</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>IBM PSSCC Innovation Lab, Center of Advanced Studies</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author><author><name sortKey="Hariz, Marwan I" sort="Hariz, Marwan I" uniqKey="Hariz M" first="Marwan I." last="Hariz">Marwan I. Hariz</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London</s1><s2>London WC1N3BG</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Unit of Functional Neurosurgery, Sobell Department, UCL Institute of Neurology</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Coubes, Philippe" sort="Coubes, Philippe" uniqKey="Coubes P" first="Philippe" last="Coubes">Philippe Coubes</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>CHRU Montpellier, Hôpital Gui de Chauliac, Departement de Neurochirurgie</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Unité de Recherche sur les Mouvements Anormaux, URMA</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>INSERM, U661</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Universite de Montpellier 1</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>CNRS UMR5203, Institut de Genomique Fonctionnelle</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation></author><author><name sortKey="Rothwell, John C" sort="Rothwell, John C" uniqKey="Rothwell J" first="John C." last="Rothwell">John C. Rothwell</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London</s1><s2>London WC1N3BG</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">11-0320385</idno><date when="2011">2011</date><idno type="stanalyst">PASCAL 11-0320385 INIST</idno><idno type="RBID">Pascal:11-0320385</idno><idno type="wicri:Area/PascalFrancis/Corpus">000387</idno><idno type="wicri:Area/PascalFrancis/Curation">000F52</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000307</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000307</idno><idno type="wicri:doubleKey">0006-8950:2011:Ruge D:shaping:reversibility:long</idno><idno type="wicri:Area/Main/Merge">001897</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Shaping reversibility? Long-term deep brain stimulation in dystonia: the relationship between effects on electrophysiology and clinical symptoms</title><author><name sortKey="Ruge, Dian" sort="Ruge, Dian" uniqKey="Ruge D" first="Dian" last="Ruge">Dian Ruge</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London</s1><s2>London WC1N3BG</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Unit of Functional Neurosurgery, Sobell Department, UCL Institute of Neurology</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Cif, Laura" sort="Cif, Laura" uniqKey="Cif L" first="Laura" last="Cif">Laura Cif</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>CHRU Montpellier, Hôpital Gui de Chauliac, Departement de Neurochirurgie</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Unité de Recherche sur les Mouvements Anormaux, URMA</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>INSERM, U661</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Universite de Montpellier 1</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>CNRS UMR5203, Institut de Genomique Fonctionnelle</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation></author><author><name sortKey="Limousin, Patricia" sort="Limousin, Patricia" uniqKey="Limousin P" first="Patricia" last="Limousin">Patricia Limousin</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London</s1><s2>London WC1N3BG</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Unit of Functional Neurosurgery, Sobell Department, UCL Institute of Neurology</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Gonzalez, Victoria" sort="Gonzalez, Victoria" uniqKey="Gonzalez V" first="Victoria" last="Gonzalez">Victoria Gonzalez</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>CHRU Montpellier, Hôpital Gui de Chauliac, Departement de Neurochirurgie</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Unité de Recherche sur les Mouvements Anormaux, URMA</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>INSERM, U661</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Universite de Montpellier 1</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>CNRS UMR5203, Institut de Genomique Fonctionnelle</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation></author><author><name sortKey="Vasques, Xavier" sort="Vasques, Xavier" uniqKey="Vasques X" first="Xavier" last="Vasques">Xavier Vasques</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>IBM PSSCC Innovation Lab, Center of Advanced Studies</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation></author><author><name sortKey="Hariz, Marwan I" sort="Hariz, Marwan I" uniqKey="Hariz M" first="Marwan I." last="Hariz">Marwan I. Hariz</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London</s1><s2>London WC1N3BG</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Unit of Functional Neurosurgery, Sobell Department, UCL Institute of Neurology</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Coubes, Philippe" sort="Coubes, Philippe" uniqKey="Coubes P" first="Philippe" last="Coubes">Philippe Coubes</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>CHRU Montpellier, Hôpital Gui de Chauliac, Departement de Neurochirurgie</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Unité de Recherche sur les Mouvements Anormaux, URMA</s1><s2>Montpellier</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>INSERM, U661</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Universite de Montpellier 1</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>CNRS UMR5203, Institut de Genomique Fonctionnelle</s1><s2>Montpellier, 34000</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Languedoc-Roussillon</region></placeName></affiliation></author><author><name sortKey="Rothwell, John C" sort="Rothwell, John C" uniqKey="Rothwell J" first="John C." last="Rothwell">John C. Rothwell</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London</s1><s2>London WC1N3BG</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation></author></analytic><series><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Deep brain stimulation</term><term>Dystonia</term><term>Electrophysiology</term><term>Long term</term><term>Nervous system diseases</term><term>Neurophysiology</term><term>Reversibility</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Dystonie</term><term>Pathologie du système nerveux</term><term>Réversibilité</term><term>Long terme</term><term>Electrophysiologie</term><term>Neurophysiologie</term><term>Stimulation cérébrale profonde</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Long-term results show that benefits from chronic deep brain stimulation in dystonia are maintained for many years. Despite this, the neurophysiological long-term consequences of treatment and their relationship to clinical effects are not well understood. Previous studies have shown that transcranial magnetic stimulation measures of abnormal long-term potentiation-like plasticity (paired associative stimulation) and GABAa-ergic inhibition (short-interval intracortical inhibition), which are seen in dystonia, normalize after several months of deep brain stimulation. In the present study, we examine the same measures in a homogenous group of 10 DYT1 gene-positive patients after long-term deep brain stimulation treatment for at least 4.5 years. Recordings were made 'on' deep brain stimulation and after stopping deep brain stimulation for 2 days. The results show that: (i) on average, prior to discontinuing deep brain stimulation, the paired associative stimulation response was almost absent and short-interval intracortical inhibition was reduced compared with normal. This pattern differs from that in both healthy volunteers and from the typical pattern of enhanced plasticity and reduced inhibition seen in deep brain stimulation-naive dystonia. It is similar to that seen in untreated Parkinson's disease and may relate to thus far unexplained clinical phenomena like parkinsonian symptoms that have sometimes been observed in patients treated with deep brain stimulation. (ii) Overall, there was no change in average physiological or clinical status when deep brain stimulation was turned off for 2 days, suggesting that deep brain stimulation had produced long-term neural reorganization in the motor system. (iii) However, there was considerable variation between patients. Those who had higher levels of plasticity when deep brain stimulation was 'on', had the best retention of clinical benefit when deep brain stimulation was stopped and vice versa. This may indicate that better plasticity is required for longer term retention of normal movement when deep brain stimulation is off. (iv) Patients with the highest plasticity 'on' deep brain stimulation were those who had been receiving stimulation with the least current drain. This suggests that it might be possible to 'shape' deep brain stimulation of an individual patient to maximize beneficial neurophysiological patterns that have an impact on clinical status. The results are relevant for understanding long-term consequences and management of deep brain stimulation in dystonia.</div></front></TEI><affiliations><list><country><li>France</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Languedoc-Roussillon</li><li>Occitanie (région administrative)</li></region><settlement><li>Londres</li><li>Montpellier</li></settlement><orgName><li>University College de Londres</li></orgName></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Ruge, Dian" sort="Ruge, Dian" uniqKey="Ruge D" first="Dian" last="Ruge">Dian Ruge</name></region><name sortKey="Hariz, Marwan I" sort="Hariz, Marwan I" uniqKey="Hariz M" first="Marwan I." last="Hariz">Marwan I. Hariz</name><name sortKey="Hariz, Marwan I" sort="Hariz, Marwan I" uniqKey="Hariz M" first="Marwan I." last="Hariz">Marwan I. Hariz</name><name sortKey="Limousin, Patricia" sort="Limousin, Patricia" uniqKey="Limousin P" first="Patricia" last="Limousin">Patricia Limousin</name><name sortKey="Limousin, Patricia" sort="Limousin, Patricia" uniqKey="Limousin P" first="Patricia" last="Limousin">Patricia Limousin</name><name sortKey="Rothwell, John C" sort="Rothwell, John C" uniqKey="Rothwell J" first="John C." last="Rothwell">John C. Rothwell</name><name sortKey="Ruge, Dian" sort="Ruge, Dian" uniqKey="Ruge D" first="Dian" last="Ruge">Dian Ruge</name></country><country name="France"><region name="Occitanie (région administrative)"><name sortKey="Cif, Laura" sort="Cif, Laura" uniqKey="Cif L" first="Laura" last="Cif">Laura Cif</name></region><name sortKey="Cif, Laura" sort="Cif, Laura" uniqKey="Cif L" first="Laura" last="Cif">Laura Cif</name><name sortKey="Cif, Laura" sort="Cif, Laura" uniqKey="Cif L" first="Laura" last="Cif">Laura Cif</name><name sortKey="Cif, Laura" sort="Cif, Laura" uniqKey="Cif L" first="Laura" last="Cif">Laura Cif</name><name sortKey="Cif, Laura" sort="Cif, Laura" uniqKey="Cif L" first="Laura" last="Cif">Laura Cif</name><name sortKey="Coubes, Philippe" sort="Coubes, Philippe" uniqKey="Coubes P" first="Philippe" last="Coubes">Philippe Coubes</name><name sortKey="Coubes, Philippe" sort="Coubes, Philippe" uniqKey="Coubes P" first="Philippe" last="Coubes">Philippe Coubes</name><name sortKey="Coubes, Philippe" sort="Coubes, Philippe" uniqKey="Coubes P" first="Philippe" last="Coubes">Philippe Coubes</name><name sortKey="Coubes, Philippe" sort="Coubes, Philippe" uniqKey="Coubes P" first="Philippe" last="Coubes">Philippe Coubes</name><name sortKey="Coubes, Philippe" sort="Coubes, Philippe" uniqKey="Coubes P" first="Philippe" last="Coubes">Philippe Coubes</name><name sortKey="Gonzalez, Victoria" sort="Gonzalez, Victoria" uniqKey="Gonzalez V" first="Victoria" last="Gonzalez">Victoria Gonzalez</name><name sortKey="Gonzalez, Victoria" sort="Gonzalez, Victoria" uniqKey="Gonzalez V" first="Victoria" last="Gonzalez">Victoria Gonzalez</name><name sortKey="Gonzalez, Victoria" sort="Gonzalez, Victoria" uniqKey="Gonzalez V" first="Victoria" last="Gonzalez">Victoria Gonzalez</name><name sortKey="Gonzalez, Victoria" sort="Gonzalez, Victoria" uniqKey="Gonzalez V" first="Victoria" last="Gonzalez">Victoria Gonzalez</name><name sortKey="Gonzalez, Victoria" sort="Gonzalez, Victoria" uniqKey="Gonzalez V" first="Victoria" last="Gonzalez">Victoria Gonzalez</name><name sortKey="Vasques, Xavier" sort="Vasques, Xavier" uniqKey="Vasques X" first="Xavier" last="Vasques">Xavier Vasques</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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