title: Bilateral, pallidal, deep-brain stimulation in primary generalised dystonia: a prospective 3 year follow-up study.
abstract: BACKGROUND
  We have previously reported the efficacy and safety of bilateral pallidal stimulation for primary generalised dystonia in a prospective, controlled, multicentre study with 1 year of follow-up. Although long-term results have been reported by other groups, no controlled assessment of motor and non-motor results is available. In this prospective multicentre 3 year follow-up study, involving the same patients as those enrolled in the 1 year follow-up study, we assessed the effect of bilateral pallidal stimulation on motor impairment, disability, quality of life, cognitive performance, and mood.
  
  
  METHODS
  We studied 22 patients with primary generalised dystonia after 3 years of bilateral pallidal stimulation. We compared outcome at 3 years with their status preoperatively and after 1 year of treatment. Standardised video recordings were scored by an independent expert. Data were analysed on an intention-to-treat basis.
  
  
  RESULTS
  Motor improvement observed at 1 year (51%) was maintained at 3 years (58%). The improvement in quality of life (SF-36 questionnaire) was similar to that observed at 1 year. Relative to baseline and to the 1 year assessment, cognition and mood were unchanged 3 years after surgery, but slight improvements were noted in concept formation, reasoning, and executive functions. Pallidal stimulation was stopped bilaterally in three patients because of lack of improvement, technical dysfunction, and infection, and unilaterally in two patients because of electrode breakage and stimulation-induced contracture. No permanent adverse effects were observed.
  
  
  CONCLUSIONS
  Bilateral pallidal stimulation provides sustained motor benefit after 3 years. Mild long-term improvements in quality of life and attention were also observed.
authors.affiliation: INSERM U679, Neurology and Experimental Therapeutics, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. marie.vidailhet@sat.aphp.fr
authors.forename: Marie
authors.initials: M
authors.lastname: Vidailhet
authors.forename: Laurent
authors.initials: L
authors.lastname: Vercueil
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Houeto
authors.forename: Pierre
authors.initials: P
authors.lastname: Krystkowiak
authors.forename: Christelle
authors.initials: C
authors.lastname: Lagrange
authors.forename: Jerôme
authors.initials: J
authors.lastname: Yelnik
authors.forename: Eric
authors.initials: E
authors.lastname: Bardinet
authors.forename: Alim-Louis
authors.initials: AL
authors.lastname: Benabid
authors.forename: Soledad
authors.initials: S
authors.lastname: Navarro
authors.forename: Didier
authors.initials: D
authors.lastname: Dormont
authors.forename: Sylvie
authors.initials: S
authors.lastname: Grand
authors.forename: Serge
authors.initials: S
authors.lastname: Blond
authors.forename: Claire
authors.initials: C
authors.lastname: Ardouin
authors.forename: Bernard
authors.initials: B
authors.lastname: Pillon
authors.forename: Katy
authors.initials: K
authors.lastname: Dujardin
authors.forename: Valérie
authors.initials: V
authors.lastname: Hahn-Barma
authors.forename: Yves
authors.initials: Y
authors.lastname: Agid
authors.forename: Alain
authors.initials: A
authors.lastname: Destée
authors.forename: Pierre
authors.initials: P
authors.lastname: Pollak
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D017668:Age of Onset; D003071:Cognition / Q000502:physiology; D046690:Deep Brain Stimulation; D004185:Disability Evaluation; D004421:Dystonia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018832:Molecular Chaperones / Q000235:genetics; D009068:Movement / Q000502:physiology; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018832:Molecular Chaperones; C108175:TOR1A protein, human