{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T11:46:49Z","timestamp":1791028009788,"version":"4.1.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,5]]},"abstract":"\nObject<\/jats:title>\nDeep brain stimulation (DBS) is used for treating various types of dystonia. Multiple electrodes could be proposed to improve the therapeutic outcome enabling the targeting of specific neuronal populations not reached by the electrical field generated by the initially implanted electrode. The authors address the question of the feasibility and safety of staged multiple lead implantations in the sensorimotor internal globus pallidus (GPi) in primary generalized dystonia (PGD). Criteria for patient selection, surgical technique, target selection, electrical settings management, and clinical outcome are presented.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nSixteen patients (8 harbored the DYT1<\/jats:italic> gene mutation) presented with PGD and were enrolled in this study. Patients underwent clinical assessment using the Burke-Fahn-Marsden Dystonia Rating Scale preoperatively and during follow-up with DBS. Prior to the addition of electrodes, the authors confirmed, by turning off stimulation, that the patient was still benefiting from DBS and that DBS settings adjustment did not provide further improvement. The second target was defined according to the position of the first electrode, to the residual volume within the sensorimotor GPi, and according to residual symptoms. The second surgery followed the same protocol as the first and the new electrode were inserted using the same bur hole as the first electrode.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nThe addition of a new pair of electrodes was followed by significant improvement in the whole population (p = 0.005), as well as in the DYT1<\/jats:italic>-negative subgroup (p = 0.012) but not in the DYT1<\/jats:italic> subgroup (p = not significant). Nevertheless, some patients did not exhibit significant additional benefit. Seven hardware-related complications occurred during the entire follow-up, 3 prior to it, and 4 after the addition of the second pair of electrodes.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nThe addition of a second pair of electrodes in the GPi in patients with PGD with suboptimal or decaying benefit following the first surgery seems to be a safe procedure and is not followed by an increase in surgery-related complications. This staged procedure may provide further clinical improvement in patients with PGD in whom DBS effect is initially incomplete or when disease progression occurs over time. The position of the additional electrode within the GPi is determined by the available volume within the posteroventral GPi and by the distribution of the dystonic symptoms that need to be controlled.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.1.jns102045","type":"journal-article","created":{"date-parts":[[2012,2,17]],"date-time":"2012-02-17T14:58:04Z","timestamp":1329490684000},"page":"1144-1152","source":"Crossref","is-referenced-by-count":34,"title":["Staged implantation of multiple electrodes in the internal globus pallidus in the treatment of primary generalized dystonia"],"prefix":"10.3171","volume":"116","author":[{"given":"Laura","family":"Cif","sequence":"first","affiliation":[{"name":"D\u00e9partement de Neurochirurgie,"},{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale Unit\u00e9 661;"},{"name":"Universit\u00e9 de Montpellier 1;"},{"name":"Institut de G\u00e9nomique Fonctionnelle, Unit\u00e9 Mixte de Recherche 5203, Centre National de la Recherche Scientifique; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Gonzalez-Martinez","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Neurochirurgie,"},{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale Unit\u00e9 661;"},{"name":"Universit\u00e9 de Montpellier 1;"},{"name":"Institut de G\u00e9nomique Fonctionnelle, Unit\u00e9 Mixte de Recherche 5203, Centre National de la Recherche Scientifique; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Vasques","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Neurochirurgie,"},{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale Unit\u00e9 661;"},{"name":"Universit\u00e9 de Montpellier 1;"},{"name":"Institut de G\u00e9nomique Fonctionnelle, Unit\u00e9 Mixte de Recherche 5203, Centre National de la Recherche Scientifique; and"},{"name":"Product and Solution Support Center, Centre for Advanced Studies, IBM, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Corlob\u00e9","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Neurochirurgie,"},{"name":"Service de Neurologie, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Moura","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Neurochirurgie,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Bonaf\u00e9","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Neuroradiologie, H\u00f4pital Gui de Chauliac, Centre Hospitalier R\u00e9gional Universitaire Montpellier;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Coubes","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Neurochirurgie,"},{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale Unit\u00e9 661;"},{"name":"Universit\u00e9 de Montpellier 1;"},{"name":"Institut de G\u00e9nomique Fonctionnelle, Unit\u00e9 Mixte de Recherche 5203, Centre National de la Recherche Scientifique; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns102045","series-title":"Trends Neurosci","first-page":"366","article-title":"The functional anatomy of basal ganglia disorders","volume":"12","author":"Albin","year":"1989"},{"key":"b2-jns102045","series-title":"Mov Disord","first-page":"163","article-title":"Analysis of the clinical course of non-Jewish, autosomal dominant torsion dystonia","volume":"1","author":"Burke","year":"1986"},{"key":"b3-jns102045","series-title":"Neurology","first-page":"73","article-title":"Validity and reliability of a rating scale for the primary torsion dystonias","volume":"35","author":"Burke","year":"1985"},{"key":"b4-jns102045","series-title":"J Neurophysiol","first-page":"3696","article-title":"Neuronal responses to passive movement in the globus pallidus internus in primary dystonia","volume":"98","author":"Chang","year":"2007"},{"key":"b5-jns102045","series-title":"Mov Disord","first-page":"724","article-title":"Deep brain stimulation in myoclonus-dystonia syndrome","volume":"19","author":"Cif","year":"2004"},{"key":"b6-jns102045","series-title":"Mov Disord","first-page":"289","article-title":"Long-term follow-up of DYT1 dystonia patients treated by deep brain stimulation: an open-label study","volume":"25","author":"Cif","year":"2010"},{"key":"b7-jns102045","series-title":"Neurology","first-page":"133","article-title":"Neurosurgical treatment of dystonia","volume":"20","author":"Cooper","year":"1970"},{"key":"b8-jns102045","series-title":"J Neurosurg","first-page":"189","article-title":"Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results","volume":"101","author":"Coubes","year":"2004"},{"key":"b9-jns102045","series-title":"Lancet","first-page":"2220","article-title":"Treatment of DYT1-generalised dystonia by stimulation of the internal globus pallidus","volume":"355","author":"Coubes","year":"2000"},{"key":"b10-jns102045","series-title":"Stereotact Funct Neurosurg","first-page":"183","article-title":"Deep brain stimulation for dystonia. Surgical technique","volume":"78","author":"Coubes","year":"2002"},{"key":"b11-jns102045","series-title":"J Neurophysiol","first-page":"530","article-title":"Primate globus pallidus and subthalamic nucleus: functional organization","volume":"53","author":"DeLong","year":"1985"},{"key":"b12-jns102045","series-title":"Brain","first-page":"1899","article-title":"Globus pallidus internus stimulation in primary generalized dystonia: a H215O PET study","volume":"127","author":"Detante","year":"2004"},{"key":"b13-jns102045","series-title":"J Neurosci","first-page":"599","article-title":"Input-output organization of the sensorimotor striatum in the squirrel monkey","volume":"14","author":"Flaherty","year":"1994"},{"key":"b14-jns102045","series-title":"Mov Disord","first-page":"1733","article-title":"Pallidal and thalamic deep brain stimulation in myoclonus-dystonia","volume":"25","author":"Gruber","year":"2010"},{"key":"b15-jns102045","series-title":"J Comp Neurol","first-page":"238","article-title":"Comparison of the basal ganglia in rats, marmosets, macaques, baboons, and humans: volume and neuronal number for the output, internal relay, and striatal modulating nuclei","volume":"445","author":"Hardman","year":"2002"},{"key":"b17-jns102045","series-title":"Stereotact Funct Neurosurg","first-page":"146","article-title":"Safety and risk of microelectrode recording in surgery for movement disorders","volume":"78","author":"Hariz","year":"2002"},{"key":"b16-jns102045","series-title":"Acta Neurochir Suppl (Wien)","first-page":"42","article-title":"The side-effects and complications of posteroventral pallidotomy","volume":"68","author":"Hariz","year":"1997"},{"key":"b18-jns102045","series-title":"J Neurosurg","first-page":"949","article-title":"Deep brain stimulation in movement disorders: stereotactic coregistration of two-dimensional electrical field modeling and magnetic resonance imaging","volume":"103","author":"Hemm","year":"2005"},{"issue":"Suppl 3","key":"b19-jns102045","series-title":"Mov Disord","first-page":"S130","article-title":"Stereotactic imaging of the pallidal target","volume":"17","author":"Hirabayashi","year":"2002"},{"key":"b20-jns102045","series-title":"Arch Neurol","first-page":"1281","article-title":"Acute deep-brain stimulation of the internal and external globus pallidus in primary dystonia: functional mapping of the pallidum","volume":"64","author":"Houeto","year":"2007"},{"key":"b21-jns102045","series-title":"Brain","first-page":"1895","article-title":"Outcome predictors of pallidal stimulation in patients with primary dystonia: the role of disease duration","volume":"131","author":"Isaias","year":"2008"},{"key":"b22-jns102045","series-title":"Brain","first-page":"2491","article-title":"Evidence of functional somatotopy in GPi from results of pallidotomy","volume":"123","author":"Kishore","year":"2000"},{"key":"b23-jns102045","series-title":"Neurosurgery","first-page":"1361","article-title":"Pallidal stimulation for dystonia","volume":"55","author":"Krause","year":"2004"},{"key":"b24-jns102045","series-title":"J Clin Neurophysiol","first-page":"18","article-title":"Deep brain stimulation for dystonia","volume":"21","author":"Krauss","year":"2004"},{"key":"b25-jns102045","series-title":"Exp Brain Res","first-page":"251","article-title":"High-frequency microstimulation in human globus pallidus and substantia nigra","volume":"205","author":"Lafreniere-Roula","year":"2010"},{"key":"b26-jns102045","series-title":"Stereotact Funct Neurosurg","first-page":"1","article-title":"Leksell's unpublished pallidotomies of 1958\u20131962","volume":"74","author":"Laitinen","year":"2000"},{"key":"b27-jns102045","series-title":"Neurosurg Clin N Am","first-page":"105","article-title":"Pallidotomy for Parkinson's disease","volume":"6","author":"Laitinen","year":"1995"},{"key":"b28-jns102045","series-title":"Stereotact Funct Neurosurg","first-page":"41","article-title":"Ventroposterolateral pallidotomy","volume":"62","author":"Laitinen","year":"1994"},{"key":"b29-jns102045","series-title":"J Neurosurg","first-page":"53","article-title":"Leksell's posteroventral pallidotomy in the treatment of Parkinson's disease","volume":"76","author":"Laitinen","year":"1992"},{"key":"b30-jns102045","series-title":"J Hirnforsch","first-page":"31","article-title":"[Morphometric-statistical structure analysis of human striatum, pallidum and nucleus su-thalamicus. III. Nucleus subthalamicus.]","volume":"17","author":"Lange","year":"1976"},{"issue":"6 Suppl","key":"b31-jns102045","series-title":"Neurosurgery","first-page":"196","article-title":"Magnetic resonance-based deep brain stimulation technique: a series of 478 consecutive implanted electrodes with no perioperative intracerebral hemorrhage","volume":"65","author":"Maldonado","year":"2009"},{"key":"b32-jns102045","series-title":"Adv Neurol","first-page":"35","article-title":"Investigation of dystonia","volume":"50","author":"Marsden","year":"1988"},{"key":"b33-jns102045","series-title":"Clin Neurophysiol","first-page":"1239","article-title":"Uncovering the mechanism(s) of action of deep brain stimulation: activation, inhibition, or both","volume":"115","author":"McIntyre","year":"2004"},{"key":"b34-jns102045","series-title":"Brain Res Brain Res Rev","first-page":"112","article-title":"Somatotopy in the basal ganglia: experimental and clinical evidence for segregated sensorimotor channels","volume":"48","author":"Romanelli","year":"2005"},{"key":"b35-jns102045","series-title":"J Neurosci Methods","first-page":"113","article-title":"Techniques and mechanisms of action of transcranial stimulation of the human motor cortex","volume":"74","author":"Rothwell","year":"1997"},{"key":"b36-jns102045","series-title":"Mov Disord","first-page":"1929","article-title":"Bilateral deep brain stimulation of the globus pallidus internus in tardive dystonia","volume":"23","author":"Sako","year":"2008"},{"key":"b37-jns102045","series-title":"J Hirnforsch","first-page":"401","article-title":"[Morphometrical-statistical structure analysis of human striatum, pallidus and subthalamic nucleus. II. Globus pallidus.]","volume":"16","author":"Th\u00f6rner","year":"1975"},{"key":"b38-jns102045","series-title":"IEEE Trans Neural Syst Rehabil Eng","first-page":"166","article-title":"The physiological effects of pallidal deep brain stimulation in dystonia","volume":"15","author":"Tisch","year":"2007"},{"key":"b39-jns102045","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1314","article-title":"Effect of electrode contact location on clinical efficacy of pallidal deep brain stimulation in primary generalised dystonia","volume":"78","author":"Tisch","year":"2007"},{"key":"b40-jns102045","series-title":"J Neurosurg","first-page":"220","article-title":"Prognostic value of globus pallidus internus volume in primary dystonia treated by deep brain stimulation. Clinical article","volume":"110","author":"Vasques","year":"2009"},{"key":"b41-jns102045","series-title":"Stereotact Funct Neurosurg","first-page":"129","article-title":"A target-specific electrode and lead design for internal globus pallidus deep brain stimulation","volume":"88","author":"Vasques","year":"2010"},{"key":"b42-jns102045","series-title":"The Open Magnetic Resonance Journal","first-page":"1","article-title":"Cerebral magnetic resonance imaging feasibility in patients with implanted neurostimulation system for deep brain stimulation","volume":"1","author":"Vasques","year":"2008"},{"key":"b43-jns102045","series-title":"J Neurosurg","first-page":"784","article-title":"Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children","volume":"93","author":"Vayssiere","year":"2000"},{"key":"b44-jns102045","series-title":"J Neurosurg","first-page":"181","article-title":"Deep brain stimulation for dystonia confirming a somatotopic organization in the globus pallidus internus","volume":"101","author":"Vayssiere","year":"2004"},{"key":"b45-jns102045","series-title":"N Engl J Med","first-page":"459","article-title":"Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia","volume":"352","author":"Vidailhet","year":"2005"},{"issue":"Suppl 3","key":"b46-jns102045","series-title":"Mov Disord","first-page":"S69","article-title":"Mechanisms of deep brain stimulation: excitation or inhibition","volume":"17","author":"Vitek","year":"2002"},{"issue":"Suppl 3","key":"b47-jns102045","series-title":"Mov Disord","first-page":"S49","article-title":"Pathophysiology of dystonia: a neuronal model","volume":"17","author":"Vitek","year":"2002"},{"key":"b48-jns102045","series-title":"Adv Neurol","first-page":"211","article-title":"GPi pallidotomy for dystonia: clinical outcome and neuronal activity","volume":"78","author":"Vitek","year":"1998"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/5\/article-p1144.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/5\/article-p1144.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/5\/article-p1144.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T01:01:21Z","timestamp":1679878881000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/5\/article-p1144.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2012,5]]},"references-count":48,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2012.1.jns102045","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,5]]}}}