title: Motor cortex stimulation does not improve dystonia secondary to a focal basal ganglia lesion.
abstract: OBJECTIVE
  To assess the efficacy of epidural motor cortex stimulation (MCS) on dystonia, spasticity, pain, and quality of life in patients with dystonia secondary to a focal basal ganglia (BG) lesion.
  
  
  METHODS
  In this double-blind, crossover, multicenter study, 5 patients with dystonia secondary to a focal BG lesion were included. Two quadripolar leads were implanted epidurally over the primary motor (M1) and premotor cortices, contralateral to the most dystonic side. The leads were placed parallel to the central sulcus. Only the posterior lead over M1 was activated in this study. The most lateral or medial contact of the lead (depending on whether the dystonia predominated in the upper or lower limb) was selected as the anode, and the other 3 as cathodes. One month postoperatively, patients were randomly assigned to on- or off-stimulation for 3 months each, with a 1-month washout between the 2 conditions. Voltage, frequency, and pulse width were fixed at 3.8 V, 40 Hz, and 60 μs, respectively. Evaluations of dystonia (Burke-Fahn-Marsden Scale), spasticity (Ashworth score), pain intensity (visual analog scale), and quality of life (36-Item Short Form Health Survey) were performed before surgery and after each period of stimulation.
  
  
  RESULTS
  Burke-Fahn-Marsden Scale, Ashworth score, pain intensity, and quality of life were not statistically significantly modified by MCS.
  
  
  CONCLUSIONS
  Bipolar epidural MCS failed to improve any clinical feature in dystonia secondary to a focal BG lesion.
  
  
  METHODS
  This study provides Class I evidence that bipolar epidural MCS with the anode placed over the motor representation of the most affected limb failed to improve any clinical feature in dystonia secondary to a focal BG lesion.
authors: From the CHU Clermont-Ferrand, Neurology Department (I.R., P.D., F.D.), and Neurosurgery Department (J.J.L.), Clermont-Ferrand; Clermont Université (I.R., P.D., F.D.), Université d'Auvergne, Clermont-Ferrand; Movement Disorder Unit (M.A.K., P.P.), Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University and INSERM, Grenoble Institut des Neurosciences, Grenoble; Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer, Neurologie C (S.T., J.X., E.B.), and Neurochirurgie A (P.M.); Université de Lyon (S.T., E.B., P.M.), Faculte de Médecine Lyon Sud Charles Mérieux, Lyon; CHU Clermont-Ferrand (B.P.), Biostatistics Unit, DRCI, Clermont-Ferrand; Department of Neurology (M.V.), CRICM UPMC/INSERM UMR_S975 CNRS UMR7225, Brain and Spine Institute, ICM, Pierre Marie Curie Paris-6 University, Salpêtrière Hospital, Paris; Univ Bordeaux (P.B.), Institut des Maladies Neurodégénératives, UMR 5293 and Service d'Explorations Fonctionnelles du Système Nerveux, Centre Hospitalier Universitaire, Bordeaux; Université Paris Est Créteil (J.P.L.), EA 4391 and AP-HP, Hôpital Henri Mondor, Service de Physiologie, Explorations Fonctionnelles, Créteil; and CHU Grenoble (S.C.), Neurosurgery Department, Grenoble, France.
authors: Isabelle
authors: I
authors: Rieu
authors: Magaly
authors: M
authors: Aya Kombo
authors: Stéphane
authors: S
authors: Thobois
authors: Philippe
authors: P
authors: Derost
authors: Pierre
authors: P
authors: Pollak
authors: Jing
authors: J
authors: Xie
authors: Bruno
authors: B
authors: Pereira
authors: Marie
authors: M
authors: Vidailhet
authors: Pierre
authors: P
authors: Burbaud
authors: Jean Pascal
authors: JP
authors: Lefaucheur
authors: Jean Jacques
authors: JJ
authors: Lemaire
authors: Patrick
authors: P
authors: Mertens
authors: Stephan
authors: S
authors: Chabardes
authors: Emmanuel
authors: E
authors: Broussolle
authors: Franck
authors: F
authors: Durif
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D001480:Basal Ganglia Diseases / Q000150:complications* / Q000188:drug therapy; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004421:Dystonia / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy; D009483:Neuropsychological Tests; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D018408:Patch-Clamp Techniques; D014057:Tomography, X-Ray Computed; D055815:Young Adult