A practical guide to troubleshooting pallidal deep brain stimulation issues in patients with dystonia. (June 2021)

• Record Type: Journal Article
• Authors: Mulroy, Eoin; Vijiaratnam, Nirosen; De Roquemaurel, Alexis; Bhatia, Kailash P.; Zrinzo, Ludvic; Foltynie, Thomas; Limousin, Patricia
• Is Part Of: Parkinsonism & related disorders. Volume 87(2021)
• Page Start: 142
• Page End: 154
• Publication Date: 2021-06
• Subjects: Dystonia -- Deep brain stimulation -- Patient selection -- Genotype -- Phenotype; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2021.05.017
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: High frequency deep brain stimulation (DBS) of the internal portion of the globus pallidus has, in the last two decades, become a mainstream therapy for the management of medically-refractory dystonia syndromes. Such increasing uptake places an onus on movement disorder physicians to become familiar with this treatment modality, in particular optimal patient selection for the procedure and how to troubleshoot problems relating to sub-optimal efficacy and therapy-related side effects. Deep brain stimulation for dystonic conditions presents some unique challenges. For example, the frequent lack of immediate change in clinical status following stimulation alterations means that programming often relies on personal experience and local practice rather than real-time indicators of efficacy. Further, dystonia is a highly heterogeneous disorder, making the development of unifying guidelines and programming algorithms for DBS in this population difficult. Consequently, physicians may feel less confident in managing DBS for dystonia as compared to other indications e.g. Parkinson's disease. In this review, we integrate our years of personal experience of the programming of DBS systems for dystonia with a critical appraisal of the literature to produce a practical guide for troubleshooting common issues encountered in patients with dystonia treated with DBS, in the hope of improving the care for these patients. Highlights: High frequency DBS is now a mainstream therapy for medically-refractory dystonia. Movement disorder physicians should become familiar with DBS for dystonia. Unifying DBS programming algorithms are lacking in dystonia.