title: Globus pallidus internus stimulation in primary generalized dystonia: a H215O PET study.
abstract: Globus pallidus internus (GPi) deep brain stimulation (DBS) increasingly shows promising efficacy in the treatment of severe primary generalized dystonia. Functional imaging studies have shown previously that dystonia could be related to abnormal cortical activation during voluntary movement. In the present study, the effects of GPi DBS on regional cerebral blood flow (rCBF) during a motor task were studied in patients with primary generalized dystonia. rCBF was measured using H215O and PET in eight control subjects and six patients with dystonia treated with bilateral GPi DBS. Subjects were scanned at rest and while performing joystick movements. Dystonic patients were tested in two conditions: 'OFF' (stimulator bilaterally switched off) and 'ON' (unilateral stimulation). In the 'OFF' condition, compared with rest, motor activation of the most dystonic hand was associated with overactivity in the contralateral dorsolateral prefrontal cortex, gyrus frontalis medialis, superior frontal gyrus (area 10), frontoorbital cortex and thalamus. In the 'ON' condition, GPi DBS contralaterally to the most dystonic hand induced a decrease of the overactivation in the same areas, as well as the putamen. According to the present study, generalized dystonia is associated with prefrontal overactivation which can be reversed by effective GPi DBS.
authors.affiliation: Department of Biological and Clinical Neurosciences, Grenoble University Hospital, Grenoble, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Detante
authors.forename: Laurent
authors.initials: L
authors.lastname: Vercueil
authors.forename: Stéphane
authors.initials: S
authors.lastname: Thobois
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Broussolle
authors.forename: Nicolas
authors.initials: N
authors.lastname: Costes
authors.forename: Franck
authors.initials: F
authors.lastname: Lavenne
authors.forename: Stéphan
authors.initials: S
authors.lastname: Chabardes
authors.forename: Didier
authors.initials: D
authors.lastname: Lebars
authors.forename: Marie
authors.initials: M
authors.lastname: Vidailhet
authors.forename: Alim-Louis
authors.initials: AL
authors.lastname: Benabid
authors.forename: Pierre
authors.initials: P
authors.lastname: Pollak
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D020821:Dystonic Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005917:Globus Pallidus / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D009068:Movement; D011597:Psychomotor Performance; D014055:Tomography, Emission-Computed / Q000379:methods; D016896:Treatment Outcome