Navigation Links
In some dystonia cases, deep brain therapy benefits may linger after device turned off

LOS ANGELES (Feb. 12, 2013) Two patients freed from severe to disabling effects of dystonia through deep brain stimulation therapy continued to have symptom relief for months after their devices accidentally were fully or partly turned off, according to a report published online Feb. 11 in the journal Movement Disorders.

"Current thought is that symptoms will worsen within hours or days of device shut-off, but these two young men continued to have clinical benefit despite interruption of DBS therapy for several months. To our knowledge, these two cases represent the longest duration of retained benefit in primary generalized dystonia. Moreover, when these patients' symptoms did return, severity was far milder than it was before DBS," said senior author Michele Tagliati, MD, director of the Movement Disorders Program at Cedars-Sinai's Department of Neurology.

Dystonia causes muscles to contract, with the affected body part twisting involuntarily and symptoms ranging from mild to crippling. If drugs which often have undesirable side effects, especially at higher doses fail to give relief, neurosurgeons and neurologists may work together to supplement medications with deep brain stimulation, aimed at modulating abnormal nerve signals. Electrical leads are implanted in the brain one on each side and an electrical pulse generator is placed near the collarbone. The device is then programmed with a remote, hand-held controller. Tagliati is an expert in device programming, which fine-tunes stimulation for individual patients.

Few studies have looked at the consequences of interrupted DBS therapy, although one found "fairly rapid worsening of dystonia in 14 patients after interruption of stimulation for 48 hours, with symptom severity at times becoming worse than the pre-operative baseline." In another study of 10 patients with generalized dystonia, however, symptoms did not return in four patients when stimulation was discontinued for 48 hours.

Findings from the 10-patient study correlate well with these two cases, Tagliati said.

"It appears that several factors age, duration of disease, length of time the patient has received DBS treatment and stimulation parameters determine which patients may retain symptom relief after prolonged DBS interruption. Our two patients were young, 20 years old. They both began DBS therapy a relatively short time after disease onset; one at four years and the other at seven years. One had received continuous stimulation for five years and the other for 18 months before stimulation was interrupted," Tagliati said.

"We can't say for certain why these factors make the difference," he added, "But we theorize that a younger brain with shorter exposure to the negative effects of dystonia may be more responsive to therapy and have greater 'plasticity' to adapt back to normal. Both of our patients received DBS therapy at a lower energy than most patients experience, suggesting the possibility that low-frequency stimulation over an extended time may help retrain the brain's low-frequency electrical activity."

Both instances of device shut-off were accidental and were discovered during doctor visits after mild symptoms returned. The patient who had undergone five years of DBS therapy had only one stimulator turned off for about three months; the one stimulating the left side of his brain remained active. In the other patient, the left device had been off for about seven months and the right one for two months, Tagliati said.

Tagliati was senior author of a 2011 Journal of Neurology article on a study showing that for patients suffering from dystonia, deep brain therapy tends to get better, quicker results when started earlier rather than later.

"We knew from earlier work that younger patients with shorter disease duration had better clinical outcomes in the short term. In our 2011 article, we reported that they fare best in the long term, as well. That study uniquely showed that age and disease duration play complementary roles in predicting long-term clinical outcomes. The good news for older patients is that while they may not see the rapid gains of younger patients, their symptoms may gradually improve over several years," Tagliati said.


Contact: Sandy Van
Cedars-Sinai Medical Center

Related medicine news :

1. CDC: West Nile Toll Now 5,054 Cases, 228 Deaths
2. Latest West Nile Tally: 5,245 Cases, 236 Deaths
3. Breath Analyzers Often Unreliable in Houston DWI Cases, Says Attorney Joseph LaBella
4. Study Suggests Vaccine May Help Kids With Brain Cancer
5. Epilepsy Leads to More Brain Abnormalities Over Time
6. UCLA Brain Injury Research Center gets NCAA funding for research on sports concussions
7. Why is traumatic brain injury increasing among the elderly?
8. Brain Falters Near End of Life, but Games, Puzzles Might Slow Decline
9. Dental X-Rays May Be Linked to Benign Brain Tumors
10. Nonsurgical Method to Measure Brain Pressure Shows Promise
11. Researchers Map Brain Regions Linked to Intelligence
Post Your Comments:
(Date:11/25/2015)... ... November 25, 2015 , ... For the first time, Vitalalert is donating ... Beat ” campaign. The partnership between the two groups began in 2014 with Vitalalert ... cause. , MAP International was founded in 1954 and is an international Christian-based health ...
(Date:11/25/2015)... ... 2015 , ... Dental professionals who would like to become more proficient on ... Dr. Mark Iacobelli’s Advanced Implant Mentoring (AIM) CE course. Courses will be held on ... co-founders of Advanced Implant Mentoring (AIM), Dr. Iacobelli and Dr. D’Orazio are proud to ...
(Date:11/25/2015)... ... 2015 , ... The McHenry County law firm of Botto Gilbert Lancaster, ... Francisco J. Botto and Alex C. Wimmer. Attorneys Botto and Wimmer represented the claimant ... (2d) 130884WC. , According to court documents, Adcock testified that on May 10, 2010 ...
(Date:11/25/2015)... ... November 25, 2015 , ... SCOTTSDALE, ... facial plastic surgeon specializing in both surgical and non-surgical treatments, announced the expansion ... at Hobgood Facial Plastic Surgery. , Highly trained and nationally recognized for ...
(Date:11/25/2015)... ... 25, 2015 , ... In an ongoing Clinical Study conducted by an independent ... UV Angel is evaluating the efficacy of its product and its disinfection protocol. This ... beds) from May 2014 through October 2015 at a 360-bed, acute-care, academic medical center ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... , 26 november 2015 ... kondigt de geplande investering aan van ten ... de laboratoria en het mondiale hoofdkantoor in ... uitbreiding zal resulteren in extra kantoorruimte en ... aan de groeiende behoeften van de farmaceutische ...
(Date:11/26/2015)... , November 26, 2015 ... A new combination approach blends immunotherapy with Bremachlorin-photodynamic therapy ... new combination approach blends immunotherapy with Bremachlorin-photodynamic therapy for ... new combination approach blends immunotherapy with Bremachlorin-photodynamic therapy for ... has found that immunotherapy can be efficiently ...
(Date:11/26/2015)... 26, 2015 ... aanpak combineert immunotherapie met Bremachlorin-photodynamische therapie voor ... ) --> ... ) Uit ... Centrum (LUMC) blijkt ...
Breaking Medicine Technology: