title: Bilateral pallidal stimulation for "sticking-out tongue" feature in patients with primary focal tongue protrusion dystonia.
abstract: BACKGROUND
  Tongue protrusion dystonia can cause difficulty with speech, mastication, breathing, and swallowing. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a widespread therapeutic alternative for treating medically refractory dystonia. To our knowledge, detailed reports regarding DBS for tongue protrusion dystonia are rare. In this report, we describe two patients with "sticking out" tongue protrusion who had undergone bilateral GPi DBS.
  
  
  METHODS
  Operations were performed with surface electromyographic (EMG) monitoring, microelectrode recording, and macrostimulation to identify the point at which tongue kinetic cells respond most effectively. The most effective location for active contacts was identified according to burst EMG response in the posteroventral GPi.
  
  
  RESULTS
  Two years after DBS, total Burke, Fahn, and Marsden Dystonia Rating Scale scores of two patients were improved from 12.5 to 1 (92.0%) and from 13 to 1 (92.3%), respectively. One 58-year-old woman who lost 7 kg weight from not eating well improved enough to eat solid food and became free from choking. Another 54-year-old woman who had dysarthria and mumbled could speak more fluently and would not have complained difficulty in reading any more.
  
  
  CONCLUSIONS
  Stimulation on posteroventral GPi for patients with idiopathic "sticking-out" tongue movement changes EMG pattern in orofacial muscles. This fact supports a reason for modulation of unknown circuit connecting tongue-specific area in motor cortex, and basal ganglia.
authors.affiliation: Department of Neurosurgery, Severance Hospital, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Chung
authors.forename: Joo Pyung
authors.initials: JP
authors.lastname: Kim
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Chang
authors.forename: Hae Yu
authors.initials: HY
authors.lastname: Kim
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Chang
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D004421:Dystonia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D004576:Electromyography / Q000379:methods; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D014059:Tongue / Q000473:pathology*; D016896:Treatment Outcome
keywords: Deep brain stimulation; dyskinesia; dystonia; globus pallidus internus; pallidal stimulation