By Jin Woo Chang, Yoichi Katayama, Takamitsu Yamamoto
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Although it is evident that the optimal target for dystonia lies in the GPi, it is not known whether the traditional GPi target used for control of Parkinson’s disease (PD) is best for dystonia. Also many of the patients with dystonia tend to be obsessive or in an excessive anxiety state, which indicates that the background pathophysiology of dystonia also involves limbic pallidum that is 30 anterior to the GPi target for control of motor symptoms. To explore a better stimulation area and to ﬁnd any psychological changes with DBS in the more anterior pallidum, we usually implant two DBS electrodes on one side, resulting in four electrodes implanted in the brain.
Some of them had a history of psychiatric problems treated with antipsychotic medication, and the symptoms may be classiﬁed as tardive dyskinesia, but response to pallidal DBS is generally the same as those without such a psychiatric history. We also experienced some cases of dystonias due to hereditary metabolic disorders such as Lesch-Nyhan syndrome and Hallervorden-Spatz syndrome with favorable results . Although it is evident that the optimal target for dystonia lies in the GPi, it is not known whether the traditional GPi target used for control of Parkinson’s disease (PD) is best for dystonia.
The DBS electrode, which has 4 contact points numbered 0–3 sequentially from the most distal contact (0) to the most proximal contact (3), 26 was placed in such a way. The site of DBS electrode placement was veriﬁed by postoperative MRI. When DBS was found to be useful during the test stimulation period for a week, an implantable pulse generator (Soletora, Medtronic; Minneapolis, MN) was implanted into the subclavian region and connected to the DBS electrode. The stimulation parameters and contact points used for GPi-DBS were modiﬁed at each follow-up visit of the patients to our clinic on the basis of the results of neurological examination as well as patients’ reports concerning the activity of daily life.