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@ARTICLE{Pauls:835044,
      author       = {Pauls, K. Amande M. and Krauss, Joachim K. and Kämpfer,
                      Constanze E. and Kühn, Andrea A. and Schrader, Christoph
                      and Südmeyer, Martin and Allert, Niels and Benecke, Rainer
                      and Blahak, Christian and Boller, Jana K. and Fink, Gereon
                      R. and Fogel, Wolfgang and Liebig, Thomas and El Majdoub,
                      Faycal and Mahlknecht, Philipp and Kessler, Josef and
                      Mueller, Joerg and Voges, Juergen and Wittstock, Matthias
                      and Wolters, Alexander and Maarouf, Mohammad and Moro, Elena
                      and Volkmann, Jens and Bhatia, Kailash P. and Timmermann,
                      Lars},
      title        = {{C}auses of failure of pallidal deep brain stimulation in
                      cases with pre-operative diagnosis of isolated dystonia},
      journal      = {Parkinsonism $\&$ related disorders},
      volume       = {43},
      issn         = {1353-8020},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {FZJ-2017-04912},
      pages        = {38-48},
      year         = {2017},
      abstract     = {IntroductionPallidal deep brain stimulation (GPi-DBS) is an
                      effective therapy for isolated dystonia, but $10–20\%$ of
                      patients show improvement below $25–30\%.$ We here
                      investigated causes of insufficient response to GPi-DBS in
                      isolated dystonia in a cross-sectional study.MethodsPatients
                      with isolated dystonia at time of surgery, and $<30\%$
                      improvement on the Burke-Fahn-Marsden dystonia-rating-scale
                      (BFMDRS) after ≥6 months of continuous GPi-DBS were
                      videotaped ON and OFF stimulation, and history, preoperative
                      videos, brain MRI, medical records, stimulation settings,
                      stimulation system integrity, lead location, and genetic
                      information were obtained and reviewed by an expert
                      panel.Results22 patients from 11 centres were included (8
                      men, 14 women; 9 generalized, 9 segmental, 3 focal, 1
                      bibrachial dystonia; mean (range): age 48.7 (25–72) years,
                      disease duration 22.0 (2–40) years, DBS duration 45.5
                      (6–131) months). Mean BFMDRS-score was 31.7 (4–93)
                      preoperatively and 32.3 (5–101) postoperatively. Half of
                      the patients (n = 11) had poor lead positioning alone or in
                      combination with other problems (combined with: other
                      disease n = 6, functional dystonia n = 1, other problems n =
                      2). Other problems were disease other than isolated
                      inherited or idiopathic dystonia (n = 5), fixed deformities
                      (n = 2), functional dystonia (n = 3), and other causes (n =
                      1). Excluding patients with poor lead location from further
                      analysis, non-isolated dystonia accounted for $45.5\%,$
                      functional dystonia for $27.3\%,$ and fixed deformities for
                      $18.2\%.$ In patients with true isolated dystonia, lead
                      location was the most frequent problem.ConclusionAfter
                      exclusion of lead placement and stimulation programming
                      issues, non-isolated dystonia, functional dystonia and fixed
                      deformities account for the majority of GPi-DBS failures in
                      dystonia.},
      cin          = {INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406},
      pnm          = {572 - (Dys-)function and Plasticity (POF3-572)},
      pid          = {G:(DE-HGF)POF3-572},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:28690015},
      UT           = {WOS:000415393100007},
      doi          = {10.1016/j.parkreldis.2017.06.023},
      url          = {https://juser.fz-juelich.de/record/835044},
}