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C. D. Marsden - One of the best experts on this subject based on the ideXlab platform.

  • Generalised muscular weakness after botulinum toxin injections for dystonia: a report of three cases
    Journal of neurology neurosurgery and psychiatry, 1999
    Co-Authors: Kailash P. Bhatia, Alexander Münchau, Pd Thompson, V S Chauhan, Michael Hutchinson, A H V Shapira, C. D. Marsden
    Abstract:

    Three patients are reported on who developed transient generalised weakness after receiving therapeutic doses of botulinum toxin for cervical dystonia (one case) and symptomatic Hemidystonia (two cases) respectively. Clinical and electrophysiological findings were in keeping with mild botulism. All patients had received previous botulinum toxin injections without side effects and one patient continued injections without recurrence of generalised weakness. The cause is most likely presynaptic inhibition due to systemic spread of the toxin. Patients with symptomatic dystonia may be more likely to have this side effect and botulinum toxin injections in these patients should be carried out cautiously.

  • Motor reorganization in acquired Hemidystonia.
    Annals of neurology, 1995
    Co-Authors: A O Ceballos-baumann, C. D. Marsden, Richard E. Passingham, David J. Brooks
    Abstract:

    Regional cerebral blood flow (rCBF) was measured with H 2 15 O positron emission tomography in 5 patients with acquired Hemidystonia (AHD) due to structural lesions of the basal ganglia or posterior thalamus contralateral to the dystonic limb. Patients were scanned at rest and when performing paced joystick movements in freely chosen directions with the dystonic and then the unaffected arm. Findings were compared with those of 5 age-matched controls performing joystick movements with the right arm. At rest, there was decreased activity in ventroanterior thalamus, posterior thalamus, angular gyrus ipsilateral to the lesion, and bilateral frontoorbital cortex. At a similar level of significance, increased resting activity was found in lentiform nucleus, hippocampus, and anterior insula contralateral to the lesion. Using the affected arm, AHD cases showed significant overactivity of contralateral prefrontal, lateral premotor cortex, rostral supplementary motor area, anterior cingulate area 32, bilateral sensorimotor cortex (SMC) and insula, mesial parietal cortex, and ipsilateral cerebellum. There was similar frontal overactivity when the unaffected arm performed the joystick movements, though SMC and insula overactivity was contralateral rather than bilateral. The associated frontal overactivity on movement is consistent with acquired dystonia being a syndrome of thalamofrontal disinhibition due to structural disruption of basal ganglia inhibitory control. Our findings also suggest that cortical activation during movement of the unaffected limb is abnormal in acquired Hemidystonia.

Joachim K. Krauss - One of the best experts on this subject based on the ideXlab platform.

  • Dystonia associated with pontomesencephalic lesions.
    Movement disorders : official journal of the Movement Disorder Society, 2009
    Co-Authors: Thomas J. Loher, Joachim K. Krauss
    Abstract:

    Secondary dystonia is well known subsequent to lesions of the basal ganglia or the thalamus. There is evidence that brainstem lesions may also be associated with dystonia, but little is known about pathoanatomical correlations. Here, we report on a series of four patients with acquired dystonia following brainstem lesions. There were no basal ganglia or thalamic lesions. Three patients suffered tegmental pontomesencephalic hemorrhage and one patient diffuse axonal injury secondary to severe craniocerebral trauma. Dystonia developed with a delay of 1 to 14 months, at a mean delay of 6 months. The patients' mean age at onset was 33 years (range 4-56 years). All patients presented with Hemidystonia combined with cervical dystonia, and two patients had craniofacial dystonia in addition. Three patients had postural or kinetic tremors. Dystonia was persistent in three patients, and improved gradually in one. There was little response to medical treatment. One patient with Hemidystonia combined with cervical dystonia improved after thalamotomy. Overall, the phenomenology of secondary dystonia due to pontomesencephalic lesions is similar to that caused by basal ganglia or thalamic lesions. Structures involved include the pontomesencephalic tegmentum and the superior cerebellar peduncles. Such lesions are often associated with fatal outcome. While delayed occurrence of severe brainstem dystonia appears to be rare, it is possible that mild manifestations of dystonia might be ignored or not be emphasized in the presence of other disabling deficits.

  • Long-term follow-up study of chronic globus pallidus internus stimulation for posttraumatic Hemidystonia.
    Journal of neurosurgery, 2000
    Co-Authors: Thomas J. Loher, Mustafa G. Hasdemir, Jean-marc Burgunder, Joachim K. Krauss
    Abstract:

    ✓ The authors report the first case of chronic globus pallidus internus (GPi) stimulation for treatment of medically intractable Hemidystonia for which long-term follow-up data are available. The patient had developed left-sided low-frequency tremor and Hemidystonia after a severe head trauma sustained at 15 years of age. He experienced relief of the tremor but not of the Hemidystonia after a thalamotomy was performed in the right hemisphere 3 years postinjury. When the patient was 24 years old, the authors performed a magnetic resonance-guided stereotactic implantation of a monopolar electrode in the right-sided posteroventral GPi. Chronic deep brain stimulation resulted in remarkable improvement of dystonia-associated pain, phasic dystonic movements, and dystonic posture, which was accompanied by functional gain. Postoperative improvement was sustained after 4 years of follow up. Chronic GPi stimulation appears to be a valuable treatment option for posttraumatic dystonia.

  • Cerebral arteriovenous malformations and movement disorders
    Clinical neurology and neurosurgery, 1999
    Co-Authors: Joachim K. Krauss, George D. Kiriyanthan, Jan J. Borremans
    Abstract:

    A series of six patients with movement disorders associated with cerebral arteriovenous malformations (AVM) is reported. The AVMs were classified according to the Spetzler-Martin classification as grade V (one patient), grade IV (four patients), and as grade III (one patient). One patient had action-induced Hemidystonia caused by a contralateral frontoparietal AVM which compressed the putamen and was supplied partially by enlarged lenticulostriate arteries. Two patients presented with unilateral cortical tremor associated with contralateral high-frontal cortical/subcortical AVMs sparing the basal ganglia. Another patient developed Hemidystonia and hemichorea-hemiballism after bleeding of a contralateral temporooccipital AVM and subsequent ischemia. Two patients had focal dystonia after thalamic and basal ganglia hemorrhage from AVMs. Five patients were operated on. The movement disorder was abolished in one patient postoperatively. Different mechanisms were identified that are relevant for the development of AVM-related movement disorders: mass effect, diaschisis, local parenchymal altered cerebral blood flow, and hemorrhagic or ischemic structural lesions.

  • Hemidystonia secondary to carotid artery gunshot injury
    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 1997
    Co-Authors: Joachim K. Krauss, Joseph Jankovic
    Abstract:

    A 9-year-old boy was accidentally shot at close range with a pistol. The bullet entered through the left anterior neck and severed the left common carotid artery. Emergency surgery was performed with an end-to-end anastomosis. He recovered gradually from severe right-sided hemiparesis. CT scans demonstrated left parietal infarction. Within months he developed right Hemidystonia, which progressed over the next few years. The movement disorder was refractory to medical therapy. MR scans showed a large demarcated defect in the left parietal lobe extending to the occipital lobe, to the insula and to the posterior ventral putamen. At age 18 the patient underwent a staged left-sided thalamotomy. The Hemidystonia improved postoperatively but later partially recurred.

  • Dystonia following head trauma: a report of nine patients and review of the literature
    Movement disorders : official journal of the Movement Disorder Society, 1992
    Co-Authors: Joachim K. Krauss, Mohsen Mohadjer, D. F. Braus, A. K. Wakhloo, Fritz Nobbe, Fritz Mundinger
    Abstract:

    We report nine patients who developed dystonia following head trauma. The most frequent form was Hemidystonia only (six patients). One patient presented with Hemidystonia plus torticollis, one with bilateral Hemidystonia and one with torticollis only. Seven patients sustained a severe head injury, and two had a mild head injury. At the time of injury, six were younger than 10 years, two were adolescents, and the patient with torticollis only was an adult. Except in the patient with torticollis only, the onset of dystonia varied considerably from months to years. All patients with Hemidystonia had posthemiplegic dystonia of delayed onset. Seven out of 8 patients with Hemidystonia had lesions involving the contralateral caudate or putamen, as demonstrated by CT and MR. The patient with Hemidystonia plus torticollis had no lesion to the basal ganglia, but a contralateral pontomesencephalic lesion. Response to medical treatment was generally poor. Functional stereotactic operations were performed in seven patients. A variety of factors may be responsible for the vascular or nonvascular posttraumatic basal ganglia lesions, which may lead to dystonia. The pathophysiology seems to be more complex than thought previously. We believe that dystonia following head injury is not as rare as is assumed. Awareness of its characteristics and optimized diagnostic procedures will lead to wider recognition of this entity. Language: en

Jin Woo Chang - One of the best experts on this subject based on the ideXlab platform.

  • The long-term surgical outcomes of secondary Hemidystonia associated with post-traumatic brain injury
    Acta Neurochirurgica, 2012
    Co-Authors: Joo Pyung Kim, Won Seok Chang, Jin Woo Chang
    Abstract:

    Background The aim was to assess the effect of deep brain stimulation for secondary Hemidystonias associated with focal post-traumatic brain injuries. Methods Four patients underwent deep brain stimulation for the treatment of medically refractory secondary Hemidystonia associated with post-traumatic brain injury. Clinical outcome assessments were based on Burke-Fahn-Marsden Dystonia Rating Scale movement and disability scores. Health-related quality of life was assessed using a 36-item short-form general health survey questionnaire administered preoperatively and at the last follow-up visit. Results Burke-Fahn-Marsden Dystonia Rating Scale movement scores had improved by 73.2% (range, 38.1–94.1) and disability scores had improved by 75% (range, 60–100) at the 2-year follow-up visit. The health-related quality of life assessment revealed satisfactory results at follow-up, such that body pain, general health, vitality, social functioning, as well as emotional and mental health improved significantly. Conclusions Globus pallidus internus deep brain stimulation can be used to modulate and ameliorate secondary Hemidystonia associated with focal post-traumatic brain injury.

  • The long-term surgical outcomes of secondary Hemidystonia associated with post-traumatic brain injury.
    Acta neurochirurgica, 2012
    Co-Authors: Joo Pyung Kim, Won Seok Chang, Jin Woo Chang
    Abstract:

    Background The aim was to assess the effect of deep brain stimulation for secondary Hemidystonias associated with focal post-traumatic brain injuries.

  • Posttraumatic Hemidystonia treated with unilateral globus pallidus interna stimulation: Long-term follow-up and radiologic features
    Neuromodulation : journal of the International Neuromodulation Society, 2010
    Co-Authors: Dong W. Kang, Jung H. Kang, Myung Lee, Jin Woo Chang
    Abstract:

    Objective:  Hemidystonia is a unilateral clinical presentation of dystonia, and it is usually refractory to current methods of medical treatment. Recently, deep brain stimulation has given some hope of recovery to dystonic patients. Materials and Methods:  A 30-year-old right-handed man with no abnormal perinatal history or family history of movement disorders was admitted to our institution. The patient had suffered right-sided dystonia for more than three years after severe head trauma sustained four years prior. Results:  We performed a stereotactic implantation of an electrode into the left globus pallidus internus (GPi) and he showed excellent response to pallidal stimulation during long-term follow-up. Conclusions:  We present a unique case of secondary posttraumatic Hemidystonia treated with contralateral GPi stimulation with an excellent outcome. Pallidal stimulation can be a good treatment option for posttraumatic Hemidystonia in selected cases.

M. Duse - One of the best experts on this subject based on the ideXlab platform.

Jill L. Ostrem - One of the best experts on this subject based on the ideXlab platform.

  • Cerebellar Deep Brain Stimulation for Acquired Hemidystonia
    Movement disorders clinical practice, 2020
    Co-Authors: Ethan G. Brown, Ian O. Bledsoe, Nijee S. Luthra, Svjetlana Miocinovic, Philip A. Starr, Jill L. Ostrem
    Abstract:

    Background The cerebellum's role in dystonia is increasingly recognized. Dystonia can be a disabling and refractory condition; deep brain stimulation can help many patients, but it is traditionally less effective in acquired dystonia. New surgical targets would be instrumental in providing treatment options and understanding dystonia further. Objective To evaluate the efficacy of deep brain stimulation of the cerebellum in acquired dystonia. Methods We report our management of a 37-year-old woman with severe left arm and leg dystonia, a complication of an ischemic stroke in childhood. She had already had 2 thalamotomies with only transient benefit. These procedures, in addition to her initial stroke that had damaged the basal ganglia, left traditional deep brain stimulation targets unavailable. Results After implantation of bilateral deep cerebellar nuclei, dystonia improved with a 40% reduction in severity on scales and subjective reports of improved posturing, gait, and pain. This improvement has been maintained for almost 2 years after implantation. Conclusion Cerebellar stimulation has potential for therapeutic benefit in acquired dystonia and should be further explored.

  • Use of pallidal deep brain stimulation in postinfarct Hemidystonia.
    Stereotactic and functional neurosurgery, 2013
    Co-Authors: Jennifer Witt, Philip A. Starr, Jill L. Ostrem
    Abstract:

    Background/Aims: Reports of outcomes in treating dystonia secondary to stroke with deep brain stimulation (DBS) are limited. We report our experience with 3 patients, all with infarcts involving the striatum, who developed Hemidystonia and were treated with unilateral globus pallidus interna DBS. Methods: Case series describing characteristics and outcomes based on the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores before and after DBS at 3, 6 and at least 12 months. Results: All patients reported subjective improvements after surgery. At 1 year or more after surgery, none of the 3 patients displayed a measureable improvement in the BFMDRS movement score. Conclusion: Our findings are consistent with previous reports of limited benefits from pallidal DBS in secondary dystonia. Future work should focus on predictive factors for DBS outcomes and the development of more sensitive assessment tools specifically for secondary dystonias as well as the exploration of alternative brain targets for stimulation.