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Functional Mapping of the Pallidum

Jean-Luc Houeto, MD, PhD; Jérôme Yelnik, MD, PhD; Eric Bardinet, PhD; Laurent Vercueil, MD; Pierre Krystkowiak, MD, PhD; Valérie Mesnage, MD; Christelle Lagrange, PhD; Didier Dormont, MD; Jean-François Le Bas, MD; Jean-Pierre Pruvo, MD; Sophie Tezenas du Moncel, MD, PhD; Pierre Pollak, MD; Yves Agid, MD, PhD; Alain Destée, MD; Marie Vidailhet, MD; for the French Stimulation du Pallidum Interne dans la Dystonie Study Group

Arch Neurol. 2007;64(9):1281-1286.

Background  Dystonia is a syndrome characterized by prolonged muscle contractions that cause sustained twisting movements and abnormal posturing of body parts. Patients with the severe and generalized forms can benefit from bilateral high-frequency pallidal stimulation.

Objective  To investigate the functional map of the globus pallidus (GP) in patients with primary generalized dystonia.

Design  Prospective multicenter, double-blind, video-controlled study in patients treated at a university hospital.

Setting  University secondary care centers.

Patients  Twenty-two patients with primary generalized dystonia.

Interventions  Acute internal and external pallidal deep-brain stimulation or pallidal deep-brain stimulation.

Main Outcome Measures  The clinical effects of acute bilateral high-frequency ventral vs acute dorsal pallidal stimulation were assessed with the Movement subscale of the Burke-Fahn-Marsden Dystonia Rating Scale. Intrapallidal localization of the contacts of the quadripolar electrodes was performed using a 3-dimensional atlas–magnetic resonance imaging coregistration method by investigators blinded to the clinical outcome.

Results  Bilateral acute ventral stimulation of the GP significantly improved the Burke-Fahn-Marsden Dystonia Rating Scale score by 42% and resulted in stimulation of contacts located in the internal GP or medullary lamina in 18 of 21 patients. Bilateral acute dorsal pallidal stimulation, primarily localized within the external GP, had variable effects across patients, with half demonstrating slight or no improvement or even aggravation of dystonia compared with baseline.

Conclusions  Ventral pallidal stimulation, primarily of the internal GP or medullary lamina or both, is the optimal method for the treatment of dystonia. The varying effects across patients of bilateral acute dorsal pallidal stimulation, primarily of the external GP, suggest that unknown factors associated with dystonia could have a role in and contribute to the effects of the electrical stimulation.

Author Affiliations: Service de Neurologie, Centre Hospitalier Universitaire la Milétrie, Poitiers (Drs Houeto and Mesnage), Centre d’Investigation Clinique (Drs Houeto, Mesnage, and Agid), INSERM U679 (Drs Yelnik and Vidailhet); Centre National de la Recherche Scientifique UPR640 (Dr Bardinet), Services de Neuroradiologie (Dr Dormont), Département de Santé Publique, Unité de Biostatistique et d’Information Médicale et Unité de Recherche Clinique, Hôpital de la Salpêtrière (Dr du Moncel), and Neurologie, Groupe Hospitalier Pitié-Salpêtrière et Hôpital Saint-Antoine (Dr Vidaihet), Paris, France; Services de Neuroradiologie (Drs Vercueil and Le Bas) and Neurologie (Dr Pollak), Centre Hospitalier Universitaire A. Michallon (Dr Lagrange), Grenoble, France; Service de Neurologie (Drs Krystkowiak and Destée), Neuroradiologie, Hôpital R. Salengro, Centre Hospitalier Régional Universitaire de Lille (Dr Pruvo), Lille, France.
Group Information: A full list of the investigators of the French Stimulation du Pallidum Interne dans la Dystonie Study Group was published in The New England Journal of Medicine (2005;332[5]:467).