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Query: UMLS:C0013421 (dystonia)
 8,418 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors present the current views on the use of electrical stimulation in selected movement disorders (Parkinson's disease, dystonia) and pain syndromes (central and neuropathic pain) refractory to pharmacological therapy. Stimulation should be applied in cases with an established diagnosis (especially Parkinson's disease and dystonia) and with a lack of efficacy despite the best available medical therapy. Therefore it should be the last treatment option, except of generalized dystonia, where it seems to be nowadays the treatment of choice. Suggested selection criteria are based on experience of different centers and on current medical literature. They are published to make the procedure more rational and more available in Poland.
Neurol Neurochir Pol
PMID:[Deep brain stimulation and motor cortex and spinal cord stimulation in the treatment of movement disorders and pain syndromes -- the theoretical baseline and practical guidelines]. 1697 21

Spasmodic dysphonia is a focal form of laryngeal dystonia that causes unintended contractions of vocal folds with speech interruptions and affecting the voice quality. There are adductor (82%), abductor (36%), mixed (1%) types and reported by Blitzer--respiratory adductor type with paradoxical vocal fold movement and stidor. As an example of diagnostic and therapeutic difficulties in spasmodic dysphonia and its multidisciplinary approach with needed cooperation of many specialists we presented patient with adductor spasmodic dysphonia. In stroboscopic evaluation there were observed glottic overclosure and hyperaduction in supraglotic stuctures (sphincteric). During diagnostic procedures there was made acoustic analysis by digital spectrograph (by KAY Elmetrics Company). IV degree of hoarsness and voice breaks were observed in sonogram. In multidimentional analysis there were deviations of the frequency, amplitude, noise, tremor and voice break parameters. Treatment included regular speech therapy, relaxation- and psychotherapy. The results of treatment were very instable because every stress-related problem released symptoms. Botulinum toxin injections into thyro-arytenoid muscle which had made before our hospitalisation were also not succeeding. Because of lack of etiologic factor and plenty diseases that can mimic spasmodic dysphonia, close communication between many specialists is needed.
Pol Merkur Lekarski 2006 May
PMID:[Therapeutic difficulties in spasmodic dysphonia--case report]. 1687 62

Dystonia refers to movement disorders characterized by sustained muscle contractions that produce abnormal postures and twisting movements. First-line therapy for dystonia includes several classes of pharmacologic agents. Botulinum toxin injections are the treatment of choice for several forms of focal dystonia. Many patients with dystonia do not benefit from these treatments, and for those patients whose symptoms are sufficiently troublesome, surgical treatment can be used to reduce symptoms and to improve function. Formerly the ablative procedures of thalamotomy and pallidotomy were used. More recently, deep brain stimulation (DBS) has emerged not only as the preferred surgical treatment for advanced idiopathic form of Parkinson's disease and severe forms of essential tremor but also for dystonia. For dystonia, stimulation directed at the globus pallidus internus has been the most thoroughly studied to date. Advantages of DBS include its relatively non-destructive nature, its adjustability and reversibility, and its capacity to be used bilaterally in a single surgical session. Use of DBS to treat dystonia is a rapidly evolving area, and preliminary evidence suggests that primary dystonia linked to genetic mutation, especially DYT-1 positive generalized dystonia, and other primary dystonias respond most dramatically to treatment with DBS, whereas secondary dystonia tends to be less responsive.
Neurol Neurochir Pol
PMID:[Deep brain stimulation in the treatment of dystonia]. 1710 55

The authors describe the case of a female patient with the diagnosis of schizophrenia and the CYP2D6 poor metaboliser phenotype (PM phenotype), who experienced severe extrapyramidal side effects, including acute dystonia, while being treated with chloropromazine at 100 mg per day (in the third day of therapy). The CYP2D6 phenotype was determined using the sparteine test before and after 3 days of treatment. Metabolic ratio increased 12 times during treatment, from initial 30 to 355. The authors conclude that CYP2D6 poor phenotype leading to slow chloropromazine metabolism, which was further inhibited by chloropromazine during treatment (as chlorpromazine is a strong CYP2D6 enzyme inhibitor) had significant importance on the occurrence of acute extrapyramidal side effects. Most likely the antidopaminergic influence of the drug on the CNS was much more marked due to an inhibition of chlorpromazine metabolism leading probably to an increase of the chlorpromazine blood level.
Psychiatr Pol
PMID:[Acute dyskinetic syndrome during chloropromazine treatment of a female patient with CYP2D6 poor metabolism phenotype]. 1804 80

Primary generalized dystonia is a medically refractory progressive disease of the brain causing near total functional handicap of affected patients. The authors present the effectiveness of bilateral globus pallidus internus (GPi) stimulation in one patient with primary DYT-1 positive dystonia. Pharmacotherapy completely failed to control generalized dystonic movements. The patient was referred for surgical treatment and underwent bilateral implantation of DBS leads in the GPi. The formal objective assessment included the Burke-Fahn-Marsden dystonia rating scale (BFMDRS). Clinical and functional BFMDRS assessments were performed before and after surgery till 5 years postoperatively. All stimulation-induced side effects were reversible. Chronic bilateral pallidal stimulation is an effective and safe treatment in patients with primary generalized DYT-1 positive dystonia. The effectiveness of pallidal stimulation was proved by the objective validated BFMDRS assessment at 5 years follow-up examination.
Neurol Neurochir Pol
PMID:Chronic bilateral pallidal stimulation in a patient with DYT-1 positive primary generalized dystonia. A long-term follow-up study. 1836 63

Despite significant advances in psychopharmacology, many patients with psychiatric disorders remain severely impaired by their conditions in their private, professional and social lives. Deep brain stimulation (DBS) is a proven method of surgical management of Parkinson's disease, dystonia and essential tremor. Electrodes implanted in deep brain structures have a direct neuromodulatory effect on neuronal structures responsible not only for movement disorders but also for psychiatric disorders. The stereotactic targets for psychiatric disorders include limbic parts of the nuclei of the limbic neuronal loop. At present, DBS is applied to treat medically refractory obsessive-compulsive disorder, depression and Tourette syndrome in small groups of patients. This overview includes the rationale for the use of DBS in psychiatric disorders, a summary of preliminary research done to date, and a discussion of achieved results.
Neurol Neurochir Pol
PMID:[Deep brain stimulation in the surgical management of major depressive disorder and obsessive-compulsive disorder]. 2005 59

The case of 31-year-old woman suffering from schizophrenia with movement disorder is described. The patient had a 7-year history of schizophrenia. In course of the psychiatric treatment the patient presented dystonic movements within abdominal muscles. The dystonic movements were of mixed character, including voluntary and involuntary ones what might have suggested their psychogenic origin. Subsequent to the exclusion of the neurological origin of the movement disorder and poor response to antipsychotic treatment, clozapine was introduced resulting in full remission of positive symptoms and functional improvement with a diminished intensity of the involuntary movements. Psychogenic movement disorders are uncommon in schizophrenic patients. Movement disorders may occur as an adverse reaction to antipsychotic treatment, especially with typical ones. However, the abdominal muscles dystonia is an uncommon manifestation of dystonia of idiopathic, drug-induced or psychogenic origin. In such cases, a liaison between the neurologist and psychiatrist is advocated and the therapeutic process using antipsychotic treatment is necessary.
Psychiatr Pol
PMID:[Abdominal dystonia in a patient with schizophrenia: a case report]. 2020 86

The authors report a case of bilateral globus pallidus internus (GPi) stimulation for treatment of medically intractable isolated lower limb dystonia. The 14-year-old girl developed dystonic movements in her left lower limb. At the age of 17, the patient was handicapped by dystonic movements in her lower limbs, and became wheelchair-bound. Pharmacological therapy and botulinum toxin injection resulted in transient and modest benefit. Moreover, the patient was diagnosed with histologically proven coeliac disease and Langerhans cell histiocytosis. Genetic testing revealed the presence of DYT-1 mutation. The 17-year-old girl underwent bilateral implantation of deep brain stimulation leads. Bilateral GPi stimulation resulted in remarkable improvement of phasic dystonic movements, and dystonic posture of lower limbs. Over 2 years postoperative follow-up, the patient is able to walk independently. Bilateral GPi stimulation appears to be an effective treatment modality for isolated lower limb dystonia.
Neurol Neurochir Pol
PMID:Successful bilateral pallidal stimulation in a patient with isolated lower limb dystonia coexistent with Langerhans cell histiocytosis and coeliac disease. 2212 49

Adverse drug reactions deteriorate patient state, delay proper diagnosis and therapy. Drug-induced extrapyramidal syndromes caused by use of receptor D2 antagonists are relatively rare. We present a case of acute dystonia with upper limbs tremors after medication with metoclopramide and neuroleptic drugs in young patient operated on acute aortic dissection. Besides a rare comlication in the shape of right temporo-maxillary joint luxation and somatic symptoms of anxiety reaction occured, what made difficult the proper diagnosis and fast treatment.
Pol Przegl Chir 2011 Feb
PMID:Diagnostic difficulties of neurological complications after surgical treatment of acute ascending aorta dissection - a case report. 2216 88

Deep brain stimulation (DBS) is an established and accepted treatment modality of generalized dystonia. The stereotactic target to be approached with DBS leads is the internal segment of the globus pallidus (GPi). Bilateral GPi stimulation in patients suffering from primary generalized dystonia reduced dystonic movement not only in the trunk and limbs but also in the neck and face. These observations have led to the use of GPi stimulation in patients with severe torticollis and Meige syndrome refractory to pharmacological agents as well to botulinum toxin injections. An increasing number of reports indicate the effectiveness of GPi stimulation in the treatment of intractable focal and segmental dystonia. Moreover, DBS can be performed simultaneously on both sides during one operative session. This treatment modality is reversible and safer when compared to stereotactic ablative techniques. In future, DBS can become an alternative treatment for intractable focal and segmental dystonia.
Neurol Neurochir Pol
PMID:[Deep brain stimulation in the treatment of torticollis and Meige syndrome]. 2221 90


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