title: Outcome of deep brain stimulation in slowly progressive multiple system atrophy: A clinico-pathological series and review of the literature.
abstract: OBJECTIVE
  To highlight the risk of clinical worsening after deep brain stimulation in histologically proven multiple system atrophy (MSA) patients presenting slow and relatively benign disease progression mimicking Parkinson's disease (PD). In such cases but also in more typical MSA patients, the results of deep brain stimulation have been mostly reported as case reports and small patient series.
  
  
  METHODS
  The present study describes the outcome of the largest series of histologically proven MSA patients who underwent deep brain stimulation (DBS) of the subthalamic nucleus because they were considered as having PD at the time of surgery.
  
  
  RESULTS
  Three patients showed significant improvement of motor signs after surgery while two did not. Clinical improvement was short-lasting and rapidly followed by the occurrence of disabling manifestations of MSA that counteracted DBS benefits.
  
  
  CONCLUSIONS
  Together with previous reports, our study demonstrates that DBS should not be recommended for MSA patients. It also underlines that detecting subtle red flags is crucial to avoid DBS surgery in this population.
authors.affiliation: Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; Centre de référence atrophie multisystématisée, CHU de Bordeaux, F-33076 Bordeaux, France.
authors.forename: Wassilios G
authors.initials: WG
authors.lastname: Meissner
authors.affiliation: Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Expert Parkinson's Disease Center, 69000 Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, 69000 Lyon, France; CNRS, Centre de Neurosciences Cognitives, UMR5229, Bron, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Laurencin
authors.affiliation: Service de Neurologie et FMTS, CHU Strasbourg, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Tranchant
authors.affiliation: APHM, CHU Timone, Department of Neurology and Movement Disorders, and Institut de Neurosciences de La Timone UMR 7289, Aix Marseille Université, CNRS, 13385, Marseille, France.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Witjas
authors.affiliation: Service de Neurologie, CH intercommunal d'Aix-Pertuis, Laboratoire Parole et Langage UMR 7309 CNRS et université Aix-Marseille, 13616 Aix en Provence, France.
authors.forename: François
authors.initials: F
authors.lastname: Viallet
authors.affiliation: Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; Department of Clinical Neurophysiology, University Hospital Bordeaux, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Guehl
authors.affiliation: Centre d'Investigation Clinique, Department of Neurology, CHU, INSERM, Nantes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Damier
authors.affiliation: Service de Neurologie, CIC- INSERM 1402, CHU de Poitiers, Poitiers, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Houeto
authors.affiliation: Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; Centre de référence atrophie multisystématisée, CHU de Bordeaux, F-33076 Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Tison
authors.affiliation: APHM, CHU Timone, Department of Neurology and Movement Disorders, and Institut de Neurosciences de La Timone UMR 7289, Aix Marseille Université, CNRS, 13385, Marseille, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Eusebio
authors.affiliation: Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France; Department of Pathology, CHU, Bordeaux, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Vital
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Centre de Pathologie et Neuropathologie Est, service de neuropathologie, Université Claude Bernard Lyon1, CNRS UMR5239, LBMC, ENS, 69000, Lyon, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Streichenberger
authors.affiliation: Department of Pathology, CHU, Strasbourg, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Lannes
authors.affiliation: Department of Pathology, CHU, Marseille, France.
authors.forename: André
authors.initials: A
authors.lastname: Maues de Paula
authors.affiliation: Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Expert Parkinson's Disease Center, 69000 Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, 69000 Lyon, France; CNRS, Centre de Neurosciences Cognitives, UMR5229, Bron, France. Electronic address: stephane.thobois@chu-lyon.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Thobois
mesh_terms: D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009134:Muscular Atrophy, Spinal / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
keywords: Deep brain stimulation; Multiple system atrophy