title: Long-term efficacy and tolerability of bilateral pallidal stimulation to treat tardive dyskinesia.
abstract: OBJECTIVE
  To confirm the efficacy and safety of deep brain stimulation (DBS) of the internal part of the globus pallidus in improving severe tardive dyskinesia (TD).
  
  
  METHODS
  Nineteen patients with severe pharmacoresistant TD were included. All were assessed at baseline and at 3, 6 (main outcome measure), and 12 months, and in the long term (6-11 years) for 14 patients, after bilateral pallidal DBS, using motor scales (Extrapyramidal Symptoms Rating Scale [ESRS], Abnormal Involuntary Movement Scale [AIMS]), cognitive scales, and a psychiatric assessment. At 6 months, a double-blind ESRS evaluation was performed in the stimulation "on" and stimulation "off" conditions.
  
  
  RESULTS
  At 6 months, all patients had a decrease of more than 40% on the ESRS. The efficacy of the procedure was confirmed by a double-blind evaluation. This improvement was maintained at 12 months (ESRS: decrease of 58% [21%-81%];
  
  
  OBJECTIVE
  decrease of 50% [7%-77%]) and in the long term (ESRS: decrease of 60% [22%-90%];
  
  
  OBJECTIVE
  decrease of 63% [14%-94%], n = 14). All the subscores of the ESRS (parkinsonism, dystonia, and chorea) and of the AIMS (facial, oral, extremities, and trunk movements) improved. Despite psychiatric comorbidities at baseline, cognitive and psychiatric tolerability of the procedure was excellent. No cognitive decline was observed and mood was improved in most of the patients.
  
  
  CONCLUSIONS
  Pallidal DBS procedure should be considered as a therapeutic option in disabling TD refractory to medical treatment.
  
  
  METHODS
  This study provides Class II evidence that in patients with severe pharmacoresistant TD with implanted pallidal leads, the stimulation "on" condition significantly improved ESRS scores compared to the stimulation "off" condition.
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Pouclet-Courtemanche
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Tiphaine
authors.initials: T
authors.lastname: Rouaud
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Thobois
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Nguyen
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Brefel-Courbon
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Chereau
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cuny
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Derost
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Eusebio
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Guehl
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Laurencin
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mertens
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Ory-Magne
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Raoul
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Regis
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ulla
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Witjas
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Burbaud
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rascol
authors.affiliation: From the Centre d'Investigation Clinique, Department of Neurology (H.P.-C., T.R., P. Damier), Department of Medical Evaluation and Epidemiology (J.-M.N.), and Department of Neurosurgery (S.R.), CHU Nantes, INSERM; Hôpital Neurologique (S.T., C.L., P.M.), Hospices Civils de Lyon, Université de Lyon 1; Centre d'Investigation Clinique, Department of Neurology (C.B.-C., F.O.-M., O.R.), CHU Toulouse, INSERM; Departments of Psychiatry (I.C.) and Neurology (P. Derost, M.U.), CHU Clermont-Ferrand; Departments of Neurosurgery (E.C.) and Neurology (D.G., P.B.), Bordeaux CHU; and the Departments of Neurology (A.E., T.W.) and Neurosurgery (J.R.), Assistance Publique Hôpitaux de Marseille, France. philippe.damier@chu-nantes.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Damier
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition; D015331:Cohort Studies; D015897:Comorbidity; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000503:physiopathology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D009043:Motor Activity; D009069:Movement Disorders / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome