[Deep brain stimulation therapy for involuntary movements].
During the last decade, it has become clear that deep brain stimulation (DBS) therapy provides a dramatic improvement in the symptoms of movement disorders. We have experienced DBS in 110 patients with various types of involuntary movements, and confirmed the benefits of stimulation of the thalamic nucleus ventralis intermedius (Vim), internal globus pallidus (GPi) and subthalamic nucleus (STN) in these patients. DBS therapy affords the best effect on tremor when the Vim is selected as the stimulation site. DBS therapy is also useful for controlling rigidity when the GPi or STN is stimulated. Improvements of bradykinesia and gait disturbance are often induced by DBS therapy involving the GPi or STN. Dopa-induced dyskinesia can be attenuated effectively by the direct and/or indirect effects of DBS therapy. DBS of the Vim also provides excellent control of post-stroke involuntary movements, including hemiballism and hemichoreoathetosis. Dystonia in young patients is controlled effectively by DBS of GPi. Ablative procedures for control of involuntary movement disorders, such as thalamotomy and pallidotomy, always carry a risk associated with creating additional lesions in an already damaged brain. In contrast, there is not such a risk in DBS therapy. This modality of therapy is an important option in treating involuntary movements.
Katayama
Y
Y
Department of Neurological Surgery, Nihon University School of Medicine.
D020820:Dyskinesias / Q000209:etiology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005917:Globus Pallidus; D006801:Humans; D010300:Parkinson Disease / Q000150:complications; D013238:Stereotaxic Techniques; D020521:Stroke / Q000150:complications; D020651:Ventral Thalamic Nuclei