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Effects of Deep Brain Stimulation on Postural Trunk Deformities: A Systematic Review
Author(s) -
Lizarraga Karlo J.,
Fasano Alfonso
Publication year - 2019
Publication title -
movement disorders clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.754
H-Index - 18
ISSN - 2330-1619
DOI - 10.1002/mdc3.12829
Subject(s) - deep brain stimulation , medicine , parkinson's disease , dystonia , trunk , movement disorders , physical medicine and rehabilitation , physical therapy , pediatrics , disease , psychiatry , biology , ecology
Background Deep brain stimulation (DBS) effects on postural deformities are still poorly explored. Methods Systematic review in accord with the Preferred Reporting Items for Systematic review and Meta‐Analysis guidelines (PRISMA). Results All 38 studies that met predefined eligibility criteria had high risk of bias attributed to retrospective analysis of heterogeneous populations with variable and incompletely reported demographic and clinical characteristics, definitions, outcomes, DBS indications, targets, and settings. Five patient groups were identified in the 35 studies with individual data available: (1) parkinsonian camptocormia (n = 96): 89 patients underwent subthalamic (STN) and 7 globus pallidus pars interna (GPi) DBS. Camptocormia was the indication in 3 patients. After DBS, camptocormia improved in 57 of 96 patients (4.3–100% improvement) and remained stable or worsened in 39 of 96 patients (2–100% worsening). (2) dystonic camptocormia (n = 16): All underwent GPi‐DBS. They were younger and with shorter disease duration, but longer deformity duration, compared with parkinsonian camptocormia. After GPi‐DBS, camptocormia improved in all patients (50–100% improvement). (3) Parkinsonian Pisa syndrome (n = 14): 11 patients underwent STN‐DBS for motor fluctuations whereas Pisa syndrome was the indication for pedunculopontine and GPi‐DBS in 2 patients. After DBS, Pisa improved in 10 of 14 patients (33.3–66.7% improvement). (4) Dystonic opisthotonus: 2 young patients remarkably responded to GPi‐DBS. (5) Parkinsonian anterocollis: There were variable responses in 3 patients after STN‐DBS for motor fluctuations. Conclusions Low‐quality level of evidence suggests that dystonic camptocormia and opisthotonus improve after GPi‐DBS. Parkinsonian camptocormia, Pisa syndrome, and anterocollis have variable responses, and their dystonic features should be further explored.