The promise of deep brain stimulation in X-linked dystonia parkinsonism.
X-Linked dystonia parkinsonism (XDP) is a rapidly progressive and disabling neurodegenerative disease affecting mainly male Filipinos with origins from Panay Island. We reviewed all the past neurosurgical ablative procedures done for XDP patients listed in the Philippine XDP registry. From 1960 to 1982, six patients had undergone bilateral chemopallidotomies or bilateral thalomotomies staged over time. Half of these patients had significant improvement in their symptoms but five of the six patients (83%) developed postoperative morbidities, mainly speech impairment or hemiparesis. All the five reported GPi deep brain stimulation (DBS) cases for XDP were also reviewed, showing consistently immediate improvement of symptoms (61.5%-88.3% decrease in the Burke-Marsden-Fahn Dystonia Rating Scale) lasting up to a year with no adverse effects noted. We also present the first Philippine case of GPi DBS done in the youngest XDP patient to date. This present case showed dramatic improvement (88.3% decrease of the Burke-Marsden-Fahn Dystonia Rating Scale) of his dystonic symptoms, without incurring any persistent adverse effects. The results of these early cases of pallidal DBS for XDP show that DBS is generally a safe and effective procedure for alleviating the disabling symptoms of XDP in contrast to previous ablative surgeries performed on these patients.
Philippine Movement Disorder Surgery Center, Cardinal Santos Medical Center, Wilson St., MetroManila, Philippines. jettm42@yahoo.com
Jose A
JA
Aguilar
Theodor S
TS
Vesagas
Roland Dominic
RD
Jamora
Rosalia A
RA
Teleg
Lourdes
L
Ledesma
Raymond L
RL
Rosales
Hubert H
HH
Fernandez
Lillian V
LV
Lee
D000328:Adult; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D020821:Dystonic Disorders / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D040181:Genetic Diseases, X-Linked / Q000503:physiopathology / Q000628:therapy*; D005917:Globus Pallidus / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D020734:Parkinsonian Disorders / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D013238:Stereotaxic Techniques / Q000592:standards; D013788:Thalamus / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome