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Pallidal deep brain stimulation influences both reflexive and voluntary saccades in Huntington's disease

Authors

  • Adrian P. Fawcett BSc,

    1. Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Elena Moro MD,

    1. Department of Medicine, Division of Neurology, The Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Anthony E. Lang MD,

    1. Department of Medicine, Division of Neurology, The Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Andres M. Lozano PhD,

    1. Department of Surgery, Division of Neurosurgery, The Toronto Western Hospital, Toronto, Ontario, Canada
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  • William D. Hutchison PhD

    Corresponding author
    1. Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Department of Surgery, Division of Neurosurgery, The Toronto Western Hospital, Toronto, Ontario, Canada
    • Division of Neurosurgery, The Toronto Western Hospital, 399 Bathurst Street MP11-308, Toronto, Ontario, M5T 2S8 Canada
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Abstract

Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is being evaluated as a potential new therapy for patients with Huntington's disease (HD). In addition to skeletal movement disorders, HD patients have difficulty initiating voluntary saccades and have difficulty in suppressing rapid saccades toward newly appearing stimuli. We measured several saccade parameters in an HD patient who had marked improvement of clinical symptoms with bilateral GPi DBS to determine whether oculomotor performance improved in parallel with clinical scores. Oculomotor performance was assessed using three testing paradigms: pro-saccades, anti-saccades, and memory-guided saccades. The data from the HD patient was also compared to that of two healthy controls. Pallidal DBS decreased pro-saccade latency, total movement time, and the number of correctly executed trials, as well as increasing saccade gain. Memory–saccade performance was negatively affected with stimulation: saccade gain decreased, latency increased, and the patient's ability to suppress unwanted saccades decreased with stimulation. Our data demonstrate a task-specific improvement of oculomotor deficits in this HD patient with pallidal DBS, supporting a role of GPi in oculomotor control. © 2004 Movement Disorder Society

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