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Changes in blink reflex excitability after globus pallidus internus stimulation for dystonia

Authors

  • Stephen Tisch MBBS,

    1. Unit of Functional Neurosurgery, Sobell Department Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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  • Patricia Limousin MD, PhD,

    Corresponding author
    1. Unit of Functional Neurosurgery, Sobell Department Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
    • Unit of Functional Neurosurgery, Sobell Department, Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
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  • John C. Rothwell PhD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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  • Peter Asselman,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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  • Niall Quinn MD,

    1. Unit of Functional Neurosurgery, Sobell Department Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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  • Marjan Jahanshahi PhD,

    1. Unit of Functional Neurosurgery, Sobell Department Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
    2. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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  • Kailash P. Bhatia MD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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  • Marwan Hariz MD, PhD

    1. Unit of Functional Neurosurgery, Sobell Department Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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Abstract

A pathophysiological feature of dystonia is reduced inhibition at various levels of the nervous system, which may be detected in clinically unaffected body parts. Chronic deep brain stimulation (DBS) of the globus pallidus internus (GPi) has emerged as an effective treatment for primary torsion dystonia (PTD), although its mechanism of action and impact on inhibitory abnormalities in dystonia are unknown. We sought to understand the effect of GPi DBS on brainstem excitability in patients with PTD. We measured the blink reflex from orbicularis oculi in response to paired electrical stimulation of the supraorbital nerve at interstimulus intervals of 500 and 1,000 milliseconds in 10 patients with PTD before and at intervals of 1, 3, and 6 months after bilateral GPi DBS and in 10 healthy subjects. Patients were clinically evaluated using the Burke–Fahn–Marsden dystonia rating scale. We found R2 inhibition was significantly decreased in PTD patients compared with control subjects and progressively increased after GPi DBS, which correlated with clinical improvement in dystonia. We conclude that GPi DBS for PTD results in functional reorganization of the nervous system, which includes a long-term increase in brainstem inhibition. © 2006 Movement Disorder Society

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