Preservation of cognitive function in dystonia treated by pallidal stimulation.
OBJECTIVE
To assess the effects of bilateral pallidal deep brain stimulation (DBS) on mood and cognitive performance in patients with dystonia before surgery (at baseline, while patients received their usual treatment) and 12 months postoperatively (while patients received neurostimulation and their medications) in a multicenter prospective study.


METHODS
Twenty-two patients with primary generalized dystonia were evaluated with tests focused on executive functions. The authors considered the patients' severe disability and selected the following tests: Raven Progressive Matrices 38, Similarities and Arithmetic subtests of the Wechsler Adult Intelligence Scale-R, Grober and Buschke, Wisconsin Card Sorting Test (WCST), verbal fluency, Trail Making Test, and the Beck Depression Inventory. Median age at surgery was 30 years (range = 14 to 54 years), median duration of disease was 18.5 years (range = 4 to 37 years).


RESULTS
Before surgery, no patients showed cognitive decline or depression. The surgical procedure appeared to be benign cognitively. One year after surgery, free recall improved. There was a significant reduction in the number of errors in the WCST. No behavioral or mood changes were found.


CONCLUSIONS
Bilateral pallidal stimulation has a good benefit-to-risk ratio as it did not negatively affect cognitive performance and mood in primary dystonia, while a significant motor improvement was obtained. Moreover, a significant mild improvement in executive functions was observed, which may have been related either to the surgical treatment or to the marked decrease in anticholinergic drugs.
Pillon
B
B
INSERM U679, Neurology and Experimental Therapeutics, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France.
Ardouin
C
C
Dujardin
K
K
Vittini
P
P
Pelissolo
A
A
Cottencin
O
O
Vercueil
L
L
Houeto
J-L
JL
Krystkowiak
P
P
Agid
Y
Y
Destée
A
A
Pollak
P
P
Vidailhet
M
M
D000293:Adolescent; D000328:Adult; D000339:Affect; D001479:Basal Ganglia / Q000503:physiopathology; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation; D020821:Dystonic Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D005917:Globus Pallidus; D006801:Humans; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology / Q000517:prevention & control; D009043:Motor Activity; D009483:Neuropsychological Tests; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D018680:Cholinergic Antagonists