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Pallidal stimulation for cervical dystonia does not correct abnormal temporal discrimination

Authors

  • Anna Sadnicka MRCP,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Okka Kimmich MRCP,

    1. Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
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  • Claudia Pisarek,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Diane Ruge PhD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Joe Galea PhD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Panagiotis Kassavetis,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Isabel Pareés MD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Tabish Saifee MRCP,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Anna Molloy MRCP,

    1. Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
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  • David Bradley PhD,

    1. Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
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  • Sean O'Riordan PhD,

    1. Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
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  • Ludvic Zrinzo PhD,

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

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Kailash P. Bhatia MD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Patricia Limousin PhD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Thomas Foltynie PhD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • John C. Rothwell PhD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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  • Michael Hutchinson PhD,

    1. Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
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  • Mark J. Edwards PhD

    Corresponding author
    1. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
    • Correspondence to: Dr. Mark J. Edwards, Senior Lecturer and Honorary Consultant Neurologist, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Box 146, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, United Kingdom; n.j.edwards@ucl.ac.uk

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  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

Background

We investigated whether clinical improvement observed after deep brain stimulation (DBS) of the globus pallidus internus (GPi) in cervical dystonia (CD) is paralleled by the normalisation of temporal discrimination thresholds (TDTs), a marker of abnormal sensory processing in CD.

Methods

TDT was tested in 11 patients with CD after they received DBS and was compared with TDT scores from 24 patients with CD and a group of 61 controls.

Results

A clear clinical response to GPi-DBS was demonstrated (total Toronto Western Spasmodic Torticollis Rating Scale scores fell from 50 to 18; P < 0.001). In contrast, TDT remained abnormal in the CD-DBS group (P < 0.001) and was not significantly different from the abnormal TDT range observed in CD.

Conclusions

Underlying sensory abnormalities in temporal discrimination observed in dystonia do not seem to be corrected by successful GPi-DBS. This adds further data to the ongoing debate regarding which pathophysiological abnormalities observed in dystonia are likely to be causal in the genesis of the disease rather than epiphenomena observed secondary to abnormal motor activity. © 2013 International Parkinson and Movement Disorder Society

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