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NEUROLOGY 2006;66:1556-1558
© 2006 American Academy of Neurology

Preservation of cognitive function in dystonia treated by pallidal stimulation

B. Pillon, PhD, C. Ardouin, PhD, K. Dujardin, PhD, P. Vittini, MD, A. Pelissolo, MD, O. Cottencin, MD, L. Vercueil, J. -L. Houeto, MD, P. Krystkowiak, MD, PhD, Y. Agid, MD, PhD, A. Destée, MD, P. Pollak, MD, M. Vidailhet, MD for the French SPIDY Study Group*

From INSERM U679, Neurology and Experimental Therapeutics, and the Department of Neurology (B.P., Y.A., M.V.), Department of Psychiatry (A.P.), and Centre d'Investigation Clinique (Y.A.), Hôpital de la Pitié-Salpêtrière, Paris; Department of Biological and Clinical Neurosciences (C.A., P.P., L.V.), Grenoble University Hospital, and INSERM Unité 318, Joseph Fourier University, Grenoble; Neurology and Movement Disorders Unit (K.D., P.K., A.D.) and Department of Psychiatry (O.C.), Lille University Hospital; Department of Psychiatry (P.V.), Grenoble University Hospital; Department of Neurology (J.-L.H.), Poitiers University Hospital; and Department of Neurology (M.V.), Saint Antoine Hospital, Paris, France.

Address correspondence and reprint requests to Dr. Marie Vidailhet, Department of Neurology, Saint Antoine Hospital, 184 Faubourg Saint Antoine, and INSERM U 679 (former U289), 75571 Paris Cedex 12, France; e-mail: marie.vidailhet{at}sat.ap-hop-paris.fr.

Objective: To assess the effects of bilateral pallidal deep brain stimulation (DBS) on mood and cognitive performance in patients with dystonia before surgery (at baseline, while patients received their usual treatment) and 12 months postoperatively (while patients received neurostimulation and their medications) in a multicenter prospective study.

Methods: Twenty-two patients with primary generalized dystonia were evaluated with tests focused on executive functions. The authors considered the patients' severe disability and selected the following tests: Raven Progressive Matrices 38, Similarities and Arithmetic subtests of the Wechsler Adult Intelligence Scale-R, Grober and Buschke, Wisconsin Card Sorting Test (WCST), verbal fluency, Trail Making Test, and the Beck Depression Inventory. Median age at surgery was 30 years (range = 14 to 54 years), median duration of disease was 18.5 years (range = 4 to 37 years).

Results: Before surgery, no patients showed cognitive decline or depression. The surgical procedure appeared to be benign cognitively. One year after surgery, free recall improved. There was a significant reduction in the number of errors in the WCST. No behavioral or mood changes were found.

Conclusions: Bilateral pallidal stimulation has a good benefit-to-risk ratio as it did not negatively affect cognitive performance and mood in primary dystonia, while a significant motor improvement was obtained. Moreover, a significant mild improvement in executive functions was observed, which may have been related either to the surgical treatment or to the marked decrease in anticholinergic drugs.

*Members of the French SPIDY Study Group are listed in the Appendix.

Supported by a national grant (PHRC 98) from the Direction Régionale de la Recherche Clinique (DRRC) Assistance-Publique-Hôpitaux de Paris, the INSERM French National Dystonia Network and GIS Maladies Rares, and an unrestricted grant from Medtronic, Inc., Minneapolis, MN.

Disclosure: The authors report no conflicts of interest.

Received October 13, 2005. Accepted in final form February 6, 2006.






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