11-Clinical benefit of pallidal stimulation in dystonia is related to improved intracortical inhibition and local grey matter hypertrophy. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Fečíková, A.; Čejka, V.; Čapek, V.; Št'astná, D.; Růžička, F.; Urgošík, D.; Jech, R.
• Is Part Of: Clinical neurophysiology. Volume 129:Issue 4(2018:Apr.)
• Page Start: e9
• Publication Date: 2018-04
• Subjects: Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2018.01.031
• Languages: English
• ISSNs: 1388-2457

Abstract

Abstract : Background: Treatment efficacy of pallidal stimulation (GPi DBS) in dystonia varies and the benefit increases slowly, suggesting induction of slow plastic processes in regions involved with motor control. Methods: We examined 19 patients (mean age 48 ± (SD)18 years) with cervical (N = 7) or generalized dystonia (N = 12) of various origin by chronic GPi DBS for 57 ± 28 months. Voxel-based morphometry of postoperative T1-weighted images was calculated for gray matter (GM) density in every patient and compared with 20 matched controls. Paired TMS was applied to the motor cortex to elicit short-latency intracortical inhibition (SICI) of the motor evoked potential. The clinical effect of GPi DBS was expressed as a change in the dystonic score (BFMDS or TWSTRS) between actual GPi DBS ON condition and the preoperative state. Results: Dystonia patients showed increased GM density in the SMA and middle cingulate in comparison with healthy controls (p < 0.05 corrected). The SICI was lower in patients than in controls regardless of the ON and OFF conditions (p < 0.001) and its mean amplitude correlated with GM density in both cerebellar hemispheres (p < 0.05 corrected). Conclusions: Brain changes of chronically GPi DBS treated patients possibly reflect "hardwire" rebuilding of motor regions associated with functional improvement. Supported by the grant GA Č R 16-13323S .