title: A prospective, randomized, blinded assessment of multitarget thalamic and pallidal deep brain stimulation in a case of hemidystonia.
abstract: OBJECTIVE
  Dystonia is increasingly being interpreted as a multi-nodal "network" disorder. We aimed to investigate multitarget DBS (pallidal and thalamic) versus each target alone in a prospective, randomized, blinded trial in a case of hemidystonia secondary to putaminal stroke.
  
  
  METHODS
  DBS leads were implanted in the GPi and Vim/Vop and each stimulation combination (GPi, Vim/Vop, and both) was tested for three months in a single patient. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Short-Form 36 (SF-36) were completed at the end of each trial period.
  
  
  RESULTS
  Multitarget (GPi+Vim/Vop) stimulation was clinically the most effective treatment and resulted in the most improvement in function and quality of life. The patient's hemidystonia improved by 25% as measured by the BFMDRS during the multitarget stimulation trial period and at the 6-month follow-up. The patient's quality of life improved by 86% and 59% during the multitarget stimulation trial period and at the 6 month follow-up respectively.
  
  
  CONCLUSIONS
  Multitarget thalamic and pallidal DBS proved to be the most effective therapy for this patient with secondary hemidystonia due to a putaminal stroke. A single-lead approach may not be sufficient in neuromodulating a highly disorganized motor network seen in hemidystonia. Multitarget DBS should be further explored in post-stroke dystonia and may offer improved outcome in other forms of secondary dystonia with limited response to GPi DBS.
authors.affiliation: Division of Neurosurgery, University of British Columbia, Vancouver, Canada; Department of Stereotactic and Functional Neurosurgery, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Philipp J
authors.initials: PJ
authors.lastname: Slotty
authors.affiliation: Division of Neurosurgery, University of British Columbia, Vancouver, Canada.
authors.forename: Anujan
authors.initials: A
authors.lastname: Poologaindran
authors.affiliation: Division of Neurosurgery, University of British Columbia, Vancouver, Canada. Electronic address: chris.honey@telus.net.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Honey
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D004311:Double-Blind Method; D020821:Dystonic Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004567:Electrodes, Implanted; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D020146:Putaminal Hemorrhage / Q000150:complications; D011788:Quality of Life / Q000523:psychology; D011897:Random Allocation; D013788:Thalamus / Q000502:physiology*; D055815:Young Adult
keywords: Deep brain stimulation; Hemidystonia; Multitarget; Pallidal; Secondary dystonia; Thalamic