Deutsche Zeitschrift für Nervenheilkunde

Parkinson’s disease is a hypokinetic movement disorder with cardinal motor features of bradykinesia, resting tremor and rigidity. However, non-motor symptoms, such as cognitive, neuropsychiatric, sleep, autonomic and sensory disturbances are gaining increasing attention. These non-motor symptoms may be intrinsic to the disease pathology or may be results of treatment with dopaminergic agents. Given that most, if not all, patients with Parkinson’s disease will experience non-motor symptoms, it is important to be sensitive to these phenomena, especially since some non-motor signs may precede motor impairment. Treatment may include interventions independent of traditional, dopaminergic anti-Parkinson therapy or may be tailored to increase or reduce dopamine responsiveness of the symptom.

A retrospective study of a consecutive series of 19 patients with medically intractable dystonia treated with uni- or bilateral deep brain stimulation (DBS) is reported. A minimal follow-up of 6 months was available, up to eleven years in one patient. The first twelve consecutive patients (4 with primary and 8 with secondary dystonia) were treated with chronic stimulation of the posterior part of the ventrolateral thalamic nucleus (VLp). In this group global functional outcome was improved in 8 patients, although dystonia movement and disability scale scores did not show significant improvement. Of the 12 patients treated first by VLp DBS, three (1 primary and 2 secondary dystonia) underwent pallidal (GPi) DBS after the VLp DBS failed to improve their symptoms. The last seven consecutive patients (5 primary and 2 secondary dystonia) were treated directly with GPi DBS. Extracranial infection prevented chronic GPi DBS in one patient. In another GPi patient, preliminary negative tests with the electrodes discouraged implantation of the stimulators, and the patient was not treated with chronic DBS. In the remaining group of eight patients including those previously treated with VLp DBS, chronic GPi DBS resulted in a significant improvement in the dystonia movement scale and disability scores. Although this is a retrospective study dealing with dystonia of heterogeneous etiology, the results strongly suggest that GPi DBS has a better outcome than VLp DBS