Constant-Current Deep Brain Stimulation of the Globus Pallidus Internus in the Treatment of Primary Dystonia by a Novel 8-Contact (Octrode) Lead

World Neurosurg. 2017 Jul:103:45-56. doi: 10.1016/j.wneu.2017.03.091. Epub 2017 Mar 28.

Abstract

Objective: To evaluate bilateral constant-current globus pallidus internus (GPi) deep brain stimulation using an 8-contact lead.

Methods: This prospective, open-label, single-center pilot study of 10 patients assessed the feasibility of delivering bilaterally constant-current GPi deep brain stimulation with a novel 8-channel lead to treat primary dystonia using standard scales as outcome measures.

Results: Patients included 4 men and 6 women with a mean age of 35.8 years ± 9.2 (range, 27-49 years). Mean age of onset was 18.5 years ± 9.1 (range, 8-35 years), and mean disease duration was 17.3 years (range, 7-27 years). All had primary dystonia (8 generalized dystonia, 1 segmental dystonia, 1 focal dystonia). The primary variable was determined as 50% reduction in dystonia symptoms from baseline to the 6-month follow-up, as defined by the Burke-Fahn-Marsden Dystonia Rating Scale. Six patients (60.0%) achieved >50% reduction in Burke-Fahn-Marsden Dystonia Rating Scale score and were classified as responders at the 6-month follow-up. Five of these 6 responders (83.3%) sustained that response through the assessment at the end of the first year. Constant-current stimulation was associated with significant improvement in pain and quality of life in all patients. Nearly 84% of the overall improvement occurred by the end of first month after stimulation onset, documenting an early response to treatment. Axial symptoms responded the best.

Conclusions: Constant-current GPi deep brain stimulation proved safe and efficacious for treatment of primary dystonia. Motor scores improved by 54%, mostly within the first month. No phenotype-specific stimulation could be achieved, despite the capability of the new lead to stimulate specific loci within the GPi.

Keywords: Constant-current stimulation; Deep brain stimulation; Dystonia; Globus pallidus; Octrode.

MeSH terms

  • Adult
  • Deep Brain Stimulation / instrumentation
  • Deep Brain Stimulation / methods*
  • Dystonic Disorders / therapy*
  • Electrodes, Implanted
  • Female
  • Globus Pallidus*
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Prospective Studies
  • Quality of Life
  • Treatment Outcome