Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

For potentially crippling dystonia, earlier deep brain therapy gets better, quicker results

30.03.2011
Patients treated with deep brain stimulation continue to improve through the first three years, but those treated earlier in the disease process have better general outcomes

Patients suffering from dystonia, an uncommon yet potentially crippling movement disorder, get better results if they begin deep brain stimulation therapy sooner rather than later, according to an international study published in the March issue of the Journal of Neurology.

"Our data suggest that patients who begin treatment earlier in the disease process may expect a better general outcome than those with longer disease duration. Also, age at surgery appears to influence the time necessary to achieve the best clinical response, meaning that older patients need more time before reaching their potential benefit," said Michele Tagliati, M.D., director of the Movement Disorders Program at Cedars-Sinai Medical Center and the article's senior author.

Dystonia causes muscles to contract, with the affected body part twisting involuntarily and symptoms ranging from mild to severe. The Food and Drug Administration approved deep brain stimulation as a therapy for certain treatment-resistant dystonias in 2003 after approving it for essential tremor in 1997 and Parkinson's disease in 2002. The procedure recently was approved on a limited basis for obsessive-compulsive disorder.

"We knew from earlier work that younger patients with shorter disease duration had better clinical outcomes in the short term. Now we know they fare best in the long term, as well. Our study uniquely showed that age and disease duration play complementary roles in predicting long-term clinical outcomes. The good news for older patients is that while they may not see the rapid gains of younger patients, their symptoms may gradually improve over several years," said Tagliati, who is considered one of the world's top experts on the therapy.

The study involved 44 patients with generalized dystonia ranging in age from 10 to 59 years, with a midpoint of 31 years. Disease duration ranged from two to 42 years, with a midpoint of 15 years. There were three key clusters of patients whose medical records were analyzed:

Those younger than 27 and who had suffered from dystonia fewer than 17 years (17 patients)
Those older than 27 but who had suffered fewer than 17 years (eight patients)
Those older than 27 and who had suffered more than 17 years (19 patients)
Patients were evaluated on a standard dystonia rating scale at three intervals: after treatment began (baseline) and at one- and three-years. Specific results included:
Every patient experienced overall improvement in motor function – their ability to control muscles and movements -- after surgery and device activation. All ratings of individual body regions or functions such as speech (sub-scores) improved significantly at one year. Further gains were seen at three years.

Three patients' overall outcomes declined, with mild worsening of some symptoms between years one and three.

Five more patients had some worse sub-scores at year three but continued to show overall improvement and did not return to their pre-treatment impairment levels.

Patients older than 27 at the time of surgery showed an additional 10 percent average improvement between years one and three of therapy.

Thirty-two patients were taking prescription drugs before surgery but this number declined by 52 percent at year one and 80 percent at year three.

The stimulation device consists of electrical leads implanted in the brain and an electrical pulse generator located near the collarbone. The stimulator is programmed with a remote, hand-held controller to modulate abnormal nerve signals that cause dystonia's uncontrolled muscle contractions.

Dystonia is less common than Parkinson's disease – and has been more of a medical mystery, even among many movement disorders specialists. Proper surgical placement of the stimulation device and precise, individualized programming are critical to successful treatment, said Tagliati, who leads an educational course on deep brain stimulation programming every year at the American Academy of Neurology meetings. He said many cases of seemingly "failed" therapy can be corrected through expert fine-tuning of the device, along with optimal medication management.

The study was funded in part by a grant from the Bachmann-Strauss Dystonia & Parkinson Foundation and the Mariani Foundation for Paediatric Neurology. Although Tagliati and other authors receive speaking honoraria and consulting fees from Medtronic Inc., none are related to this study.

Citation: Journal of Neurology, "Factors predicting protracted improvement after pallidal DBS for primary dystonia: the role of age and disease duration." Published online ahead of print March 2, 2011.

Sandy Van | EurekAlert!
Further information:
http://www.cedars-sinai.edu

More articles from Health and Medicine:

nachricht Millions through license revenues
27.04.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht New High-Performance Center Translational Medical Engineering
26.04.2017 | Fraunhofer ITEM

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Fighting drug resistant tuberculosis – InfectoGnostics meets MYCO-NET² partners in Peru

28.04.2017 | Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

 
Latest News

Wireless power can drive tiny electronic devices in the GI tract

28.04.2017 | Medical Engineering

Ice cave in Transylvania yields window into region's past

28.04.2017 | Earth Sciences

Nose2Brain – Better Therapy for Multiple Sclerosis

28.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>