title: Longterm deep brain stimulation withdrawal: clinical stability despite electrophysiological instability.
abstract: Deep brain stimulation (DBS) is a powerful treatment option for movement disorders, including severe generalised dystonia. After several years of treatment, cases have been reported in which DBS has been stopped without any deterioration in clinical benefit. This might indicate that DBS can restore function in some cases. The mechanism of DBS induced clinical retention effects has been addressed before. Here, the question we asked was if such clinical stability is reflected at the underlying physiology level or whether there is indication to believe that a stand-still of symptoms might be at risk because of neurophysiological instability. We recorded patients with pre-intervention life-threatening or severe genetic dystonia with long lasting clinical benefit when turned off DBS. Despite clinical stability, our physiological studies revealed large changes in the excitability of excitatory and inhibitory motor circuits in the cortex, which exceed normal fluctuation. This discrepancy between instability in the motor network physiology caused by removal of DBS and clinical stability alerts as it potentially indicates a risk to fail and cause symptoms to return.
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, UCL-Institute of Neurology, University College London, 33 Queen Square, London WC1N3BG, United Kingdom. Electronic address: diane.ruge@ucl.ac.uk.
authors.forename: Diane
authors.initials: D
authors.lastname: Ruge
authors.affiliation: CHRU Montpellier, Hôpital Gui de Chauliac, Département de Neurochirurgie, Montpellier F-34000 France; Unité de Recherche sur les Mouvements Anormaux, URMA, France; INSERM, U661, Montpellier F-34000, France; Université de Montpellier 1, Montpellier F-34000, France; CNRS UMR5203, Institut de Génomique Fonctionnelle, Montpellier F-34000, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Cif
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, UCL-Institute of Neurology, University College London, 33 Queen Square, London WC1N3BG, United Kingdom.
authors.forename: Patricia
authors.initials: P
authors.lastname: Limousin
authors.affiliation: CHRU Montpellier, Hôpital Gui de Chauliac, Département de Neurochirurgie, Montpellier F-34000 France; Unité de Recherche sur les Mouvements Anormaux, URMA, France; INSERM, U661, Montpellier F-34000, France; Université de Montpellier 1, Montpellier F-34000, France; CNRS UMR5203, Institut de Génomique Fonctionnelle, Montpellier F-34000, France.
authors.forename: Victoria
authors.initials: V
authors.lastname: Gonzalez
authors.affiliation: IBM France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Vasques
authors.affiliation: CHRU Montpellier, Hôpital Gui de Chauliac, Département de Neurochirurgie, Montpellier F-34000 France; Unité de Recherche sur les Mouvements Anormaux, URMA, France; INSERM, U661, Montpellier F-34000, France; Université de Montpellier 1, Montpellier F-34000, France; CNRS UMR5203, Institut de Génomique Fonctionnelle, Montpellier F-34000, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Coubes
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, UCL-Institute of Neurology, University College London, 33 Queen Square, London WC1N3BG, United Kingdom.
authors.forename: John C
authors.initials: JC
authors.lastname: Rothwell
mesh_terms: D000293:Adolescent; D002540:Cerebral Cortex / Q000503:physiopathology*; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004421:Dystonia / Q000503:physiopathology* / Q000628:therapy*; D004525:Efferent Pathways / Q000503:physiopathology*; D055724:Electrophysiological Phenomena; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult
keywords: DBS withdrawal; Deep brain stimulation; Dystonia; Electrophysiology; Stability