Association of Pallidal Neurostimulation and Outcome Predictors With X-linked Dystonia Parkinsonism
Standard
Association of Pallidal Neurostimulation and Outcome Predictors With X-linked Dystonia Parkinsonism. / Brüggemann, Norbert; Domingo, Aloysius; Rasche, Dirk; Moll, Christian K E; Rosales, Raymond L; Jamora, Roland Dominic G; Hanssen, Henrike; Münchau, Alexander; Graf, Julia; Weissbach, Anne; Tadic, Vera; Diesta, Cid C; Volkmann, Jens; Kühn, Andrea; Münte, Thomas F; Tronnier, Volker; Klein, Christine.
in: JAMA NEUROL, Jahrgang 76, Nr. 2, 01.02.2019, S. 211-216.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Association of Pallidal Neurostimulation and Outcome Predictors With X-linked Dystonia Parkinsonism
AU - Brüggemann, Norbert
AU - Domingo, Aloysius
AU - Rasche, Dirk
AU - Moll, Christian K E
AU - Rosales, Raymond L
AU - Jamora, Roland Dominic G
AU - Hanssen, Henrike
AU - Münchau, Alexander
AU - Graf, Julia
AU - Weissbach, Anne
AU - Tadic, Vera
AU - Diesta, Cid C
AU - Volkmann, Jens
AU - Kühn, Andrea
AU - Münte, Thomas F
AU - Tronnier, Volker
AU - Klein, Christine
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Importance: Anecdotal evidence suggests that deep brain stimulation (DBS) of the internal globus pallidus (GPi) is effective in ameliorating dystonia in X-linked dystonia parkinsonism (XDP), a disease that is usually refractive to medical therapy.Objective: To determine the efficacy of GPi-DBS in a cohort of patients with XDP in a prospective study and identify predictors of postoperative outcomes.Design, Setting, and Participants: This observational prospective cohort study enrolled patients in February 2013 and was completed in December 2014. The patients were followed up for up to 46 months. Patients from the Philippines were treated in a single center in Lübeck, Germany and followed up in the Philippines. Sixteen men with XDP (mean [SD] age, 40.9 [7.3] years; disease duration, 1-6 years) from the Philippines with predominant dystonia were selected.Exposures: All patients underwent bilateral GPi-DBS in Lübeck, Germany.Main Outcomes and Measures: Clinical assessment included the motor parts of the Burke-Fahn-Marsden scale (BFMDRS-M) and the Unified Parkinson's Disease Rating Scale (UPDRS-III). T1-based basal ganglia volumetry was performed and correlated with postoperative outcomes.Results: The study participants included 16 Filipino men (mean age, 40.9 years). Masked video ratings revealed significant improvements of dystonia severity 1 week (-55%; range, -94% to 59%; P < .01) and 6 months (-59%; range, -100% to 22%; P < .001) after surgery. The UDPRS-III score also improved, albeit to a lesser extent (-19%; range, -54% to 95%; and -27%; range, -70% to 124%; respectively). Unmasked long-term follow-up confirmed the continued efficacy of GPi-DBS up to 46 months after surgery. Important secondary end points improved, including activities of daily living, pain severity, weight, and quality of life. Caudate atrophy was a predictor of a less beneficial outcome (r = 0.817, P = .004).Conclusions and Relevance: Internal globus pallidus DBS had a positive association in XDP with predominant dystonia (the primary end point) and contributed to an improved quality of life (the secondary end point). The response to DBS occurred within 1 week. Given the inverse correlation of postoperative benefit and caudate atrophy, GPi-DBS should be considered early during the disease course. Close international collaboration, training, and funding from multiple sources enabled the sustainable follow-up of patients with XDP in the Philippines.
AB - Importance: Anecdotal evidence suggests that deep brain stimulation (DBS) of the internal globus pallidus (GPi) is effective in ameliorating dystonia in X-linked dystonia parkinsonism (XDP), a disease that is usually refractive to medical therapy.Objective: To determine the efficacy of GPi-DBS in a cohort of patients with XDP in a prospective study and identify predictors of postoperative outcomes.Design, Setting, and Participants: This observational prospective cohort study enrolled patients in February 2013 and was completed in December 2014. The patients were followed up for up to 46 months. Patients from the Philippines were treated in a single center in Lübeck, Germany and followed up in the Philippines. Sixteen men with XDP (mean [SD] age, 40.9 [7.3] years; disease duration, 1-6 years) from the Philippines with predominant dystonia were selected.Exposures: All patients underwent bilateral GPi-DBS in Lübeck, Germany.Main Outcomes and Measures: Clinical assessment included the motor parts of the Burke-Fahn-Marsden scale (BFMDRS-M) and the Unified Parkinson's Disease Rating Scale (UPDRS-III). T1-based basal ganglia volumetry was performed and correlated with postoperative outcomes.Results: The study participants included 16 Filipino men (mean age, 40.9 years). Masked video ratings revealed significant improvements of dystonia severity 1 week (-55%; range, -94% to 59%; P < .01) and 6 months (-59%; range, -100% to 22%; P < .001) after surgery. The UDPRS-III score also improved, albeit to a lesser extent (-19%; range, -54% to 95%; and -27%; range, -70% to 124%; respectively). Unmasked long-term follow-up confirmed the continued efficacy of GPi-DBS up to 46 months after surgery. Important secondary end points improved, including activities of daily living, pain severity, weight, and quality of life. Caudate atrophy was a predictor of a less beneficial outcome (r = 0.817, P = .004).Conclusions and Relevance: Internal globus pallidus DBS had a positive association in XDP with predominant dystonia (the primary end point) and contributed to an improved quality of life (the secondary end point). The response to DBS occurred within 1 week. Given the inverse correlation of postoperative benefit and caudate atrophy, GPi-DBS should be considered early during the disease course. Close international collaboration, training, and funding from multiple sources enabled the sustainable follow-up of patients with XDP in the Philippines.
KW - Journal Article
U2 - 10.1001/jamaneurol.2018.3777
DO - 10.1001/jamaneurol.2018.3777
M3 - SCORING: Journal article
C2 - 30508028
VL - 76
SP - 211
EP - 216
JO - JAMA NEUROL
JF - JAMA NEUROL
SN - 2168-6149
IS - 2
ER -