GPi/GPe borderland- a potential sweet spot for deep brain stimulation for chorea in Huntington's disease?

Julia Steinhardt; Simone Zittel; Vera Tadic; Volker Tronnier; Christian Moll; Tobias Bäumer; Alexander Münchau; Dirk Rasche; Norbert Brüggemann

doi:10.1186/s42466-024-00316-5

GPi/GPe borderland- a potential sweet spot for deep brain stimulation for chorea in Huntington's disease?

Neurol Res Pract. 2024 May 23;6(1):28. doi: 10.1186/s42466-024-00316-5.

Authors

Julia Steinhardt^{1

2}, Simone Zittel³, Vera Tadic^{1

2

4}, Volker Tronnier⁵, Christian Moll³, Tobias Bäumer^{2

6}, Alexander Münchau^{2

6}, Dirk Rasche⁵, Norbert Brüggemann^{7

8

9}

Affiliations

¹ Department of Neurology and Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
² Center of Brain, Behavior, and Metabolism, University of Lübeck, Lübeck, Germany.
³ Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
⁵ Department of Neurosurgery, University of Lübeck, Lübeck, Germany.
⁶ Institute of Systems Motor Sciences, University of Lübeck, Lübeck, Germany.
⁷ Department of Neurology and Institute of Neurogenetics, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. [email protected].
⁸ Center of Brain, Behavior, and Metabolism, University of Lübeck, Lübeck, Germany. [email protected].
⁹ Institute of Neurogenetics, University of Lübeck, Lübeck, Germany. [email protected].

Abstract

Background: Pallidal deep brain stimulation (GPi-DBS) has been considered as an effective treatment option for medication-refractory Huntington's disease (HD).

Objectives: To identify stimulation-dependent effects on motor symptoms and to determine if these alterations are associated with the local impact of DBS on different pallidal parcellations.

Methods: We prospectively evaluated the effects of bilateral GPi-DBS within one year in 5 HD patients. We evaluated the effects of GPi-DBS on choreatic symptoms and UHDRS. Electrode placement in the pallidum was localized, and the local impact of DBS was estimated.

Results: The chorea subscore (p < 0.001) and UHDRS total motor score was significantly reduced postoperatively (p = 0.019). Pallidal DBS did not improve other motor symptoms. Activation of the lateral GPi/GPe was associated with improvement in choreatic symptoms (p = 0.048; r = 0.90).

Conclusions: Our findings indicate that stimulation of the lateral GPi has a stable effect on choreatic symptoms. The modulation of the electrical field is relevant for motor outcome.

Keywords: Chorea; Deep brain stimulation; Globus pallidus externus; Huntington’s disease; Volume of tissue activated.

Publication types

Letter

Abstract

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