Regional cerebral blood flow changes induced by deep brain stimulation in secondary dystonia.
OBJECTIVE
The purpose of the present study is to investigate the effect of deep brain stimulation (DBS) on regional cerebral blood flow (rCBF) in cases of secondary dystonia as well as to correlate the rCBF changes with clinical outcomes.


METHODS
Six patients with medically intractable secondary dystonia who underwent DBS surgery were included in this study. Burke-Fahn-Mardsen Dystonia Rating Scale (BFMDRS) was used for the assessment of dystonia, before and after surgery. Single photon emission computed tomography (SPECT) of the brain was performed postoperatively in the two stimulation states (ON-DBS and OFF-DBS) and the changes of rCBF in the three following brain regions of interest (ROIs): primary motor cortex, premotor and supplementary motor cortex, and prefrontal cortex were evaluated.


RESULTS
Two patients exhibited excellent response to DBS, two patients got moderate benefit after the procedure, and in two patients, no clinical improvement was achieved. A mean improvement of 49.1% (0-90.7%) in BFMDRS total scores was found postoperatively. Brain SPECT data analysis revealed an overall decrease in rCBF in the investigated ROIs, during the ON-DBS state. Clinical improvement was significantly correlated with the observed decrease in rCBF in the presence of DBS.


CONCLUSIONS
When conservative treatment fails to relieve severely disabled patients suffering from secondary dystonia, DBS may be a promising therapeutic alternative. Moreover, this study indicates a putative role of brain SPECT imaging as a postoperative indicator of clinical responsiveness to DBS.
Kefalopoulou
Zinovia
Z
Functional Neurosurgery Unit, Department of Neurosurgery, Medical School of Patras, Patras, Greece.
Paschali
Anna
A
Markaki
Elli
E
Ellul
John
J
Chroni
Elisabeth
E
Vassilakos
Pavlos
P
Constantoyannis
Constantine
C
D000328:Adult; D046690:Deep Brain Stimulation; D004292:Dominance, Cerebral / Q000502:physiology; D020821:Dystonic Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000098:blood supply* / Q000000981:diagnostic imaging; D009460:Neurologic Examination; D038361:Neuronavigation; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology*; D013223:Statistics as Topic; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult