Deep brain stimulation in the treatment of dyskinesia and dystonia.
Deep brain stimulation (DBS) has become a mainstay of treatment for patients with movement disorders. This modality is directed at modulating pathological activity within basal ganglia output structures by stimulating some of their nuclei, such as the subthalamic nucleus (STN) and the globus pallidus internus (GPi), without making permanent lesions. With the accumulation of experience, indications for the use of DBS have become clearer and the effectiveness and limitations of this form of therapy in different clinical conditions have been better appreciated. In this review the authors discuss the efficacy of DBS in the treatment of dystonia and levodopa-induced dyskinesias. The use of DBS of the STN and GPi is very effective for the treatment of movement disorders induced by levodopa. The relative benefits of using the GPi as opposed to the STN as a target are still being investigated. Bilateral GPi stimulation is gaining importance in the therapeutic armamentarium for the treatment of dystonia. The DYT1 forms of generalized dystonia and cervical dystonias respond to DBS better than secondary dystonia does. Discrimination between the diverse forms of dystonia and a better understanding of the pathophysiological features of this condition will serve as a platform for improved outcomes.
Toda
Hiroki
H
Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Cananda.
Hamani
Clement
C
Lozano
Andres
A
D004409:Dyskinesia, Drug-Induced / Q000209:etiology / Q000628:therapy; D020820:Dyskinesias / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D020821:Dystonic Disorders / Q000145:classification / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods; D004567:Electrodes, Implanted; D005917:Globus Pallidus / Q000503:physiopathology; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D018832:Molecular Chaperones / Q000235:genetics / Q000502:physiology; D010300:Parkinson Disease / Q000188:drug therapy / Q000628:therapy; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology; D016896:Treatment Outcome
D018832:Molecular Chaperones; C108175:TOR1A protein, human; D007980:Levodopa