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NEW YORK (Reuters Health) Jul 20 - The success of functional neurosurgery -- deep brain stimulation for Tourette's syndrome and myoclonus-dystonia syndrome and pallidotomy for tardive dyskinesia -- suggests that these procedures may have a role in treating a variety of movement disorders, according to a series of case reports in the July issue of the Journal of Neurology, Neurosurgery, and Psychiatry.
To treat a case of severe Tourette's syndrome in a 36-year-old patient, Dr. Y. Agid, from Hopital de la Salpetriere in Paris, and colleagues implanted electrodes for deep brain stimulation bilaterally in the centromedian-parafascicular complex of the thalamus and the internal part of the globus pallidus. The patient had failed multiple trials of psychotropic and neuroleptic medications.
"From the moment the patient awakened after the operation, there was a spectacular improvement in tic severity and self-injurious behavior," Dr. Agid's group reports. The therapeutic benefit persisted for 24 months after implantation of the electrodes. Thalamic stimulation also resulted in improved mood, anxiety, and impulsivity.
Dr. Carlos Magarinos-Ascone of Hospital Ramon y Cajal in Madrid, Spain, implemented deep brain stimulation in the internal segment of the globus pallidus in a 26-year-old man with myoclonus-dystonia syndrome who had failed conventional therapy. The physicians observed immediate benefit when pallidal stimulation was started.
Unilateral stimulation relieved symptoms on the most affected side. However, symptoms of the less affected side became more obvious and a second electrode was implanted 1 year after the first. Twelve months after the second surgery, Dr. Magarinos-Ascone and his colleagues report that myoclonus was completely relieved.
According to the third Journal report, Dr. H. P. J. Buschman, at Medical Spectrum Twente in Enschede, the Netherlands, treated a 51-year-old man with schizophrenia and severe tardive dyskinesia secondary to antipsychotic treatment, most pronounced on his right side.
They performed a posteroventral pallidotomy on the left side, resulting in immediate, total disappearance of abnormal movements. Five years later, Dr. Buschman's group notes, "he is still functioning very well, with no signs of recurrence of dyskinesia and dystonia."
In an editorial summarizing these results, Drs. P. Limousin-Dowsey and S. Tisch, from the Institute of Neurology in London, point out that movement disorders such as these may be accompanied by psychiatric problems.
"Therefore," they advise, "it is particularly important in those patients to have a multidisciplinary team to discuss the specific ethical issues, establish strict criteria of selection, and evaluate the impact of surgery on all aspects of the disease."
J Neurol Neurosurg Psychiatry 2005;76:904,992-995,989-991,1039.
