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The physiological effects of pallidal deep brain stimulation in dystonia

Tisch, S; Rothwell, JC; Limousin, P; Hariz, MI; Corcos, DM; (2007) The physiological effects of pallidal deep brain stimulation in dystonia. IEEE T NEUR SYS REH , 15 (2) 166 - 172. 10.1109/TNSRE.2007.896994.

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Abstract

Dystonia is an involuntary movement disorder characterized by muscle contractions causing abnormal postures and spasms, affecting part or all of the body. Dystonia may be primary where an abnormal gene, most commonly DYT1, may be identified, or secondary to structural brain lesions or heredodegenerative disorders. The underlying defect is believed to be abnormal basal ganglia modulation of cortical motor pathways, and various motor and sensory physiological abnormalities have been demonstrated. The failure of medical treatment in many patients with the more severe and generalized forms of dystonia has led to renewed interest in neurosurgical treatment approaches. In recent years, deep brain stimulation (DBS) of globus pallidus internus (GPi) has emerged as an effective treatment for dystonia, particularly patients with primary generalized dystonia, where remarkable improvement may occur. In contrast to Parkinson's disease, the beneficial effects of DBS in dystonia are not immediate but progressive over weeks to months. Physiological and imaging studies in dystonia patients with GPi DBS have demonstrated both short and long-term effects of GPi DBS on motor cortex and subcortical circuits including progressive normalization of spinal and brainstem excitability after GPi DBS which correlate with clinical improvement. These effects, in light of existing physiological data in dystonia, suggest that GPi DBS acts primarily by major modification of basal ganglia output to brainstem, thalamus, and cortex resulting in neural reorganization, which may explain the characteristic progressive improvement in dystonia after GPi DBS.

Type: Article
Title: The physiological effects of pallidal deep brain stimulation in dystonia
DOI: 10.1109/TNSRE.2007.896994
Keywords: dystonia, neurophysiology, pallidal deep brain stimulation (DBS), PRIMARY GENERALIZED DYSTONIA, FIELD POTENTIAL ACTIVITY, FOCAL HAND DYSTONIA, GLOBUS-PALLIDUS, RECIPROCAL INHIBITION, WRITERS CRAMP, NEURONAL-ACTIVITY, PARKINSONS-DISEASE, BLINK REFLEX, SPATIAL DISCRIMINATION
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases
URI: http://discovery.ucl.ac.uk/id/eprint/136401
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