Can Pallidal Deep Brain Stimulation Rescue Borderline Dystonia? Possible Coexistence of Functional (Psychogenic) and Organic Components

Morigaki, Ryoma; Miyamoto, Ryosuke; Mure, Hideo; Fujita, Koji; Matsuda, Taku; Yamamoto, Yoko; Nakataki, Masahito; Okahisa, Tetsuya; Matsumoto, Yuki; Miyake, Kazuhisa; Yamamoto, Nobuaki; Kaji, Ryuji; Takagi, Yasushi; Goto, Satoshi

doi:10.3390/brainsci10090636

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Can Pallidal Deep Brain Stimulation Rescue Borderline Dystonia? Possible Coexistence of Functional (Psychogenic) and Organic Components

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Department of Advanced Brain Research, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan

Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan

Parkinson’s Disease and Dystonia Research Center, Tokushima University Hospital, Tokushima 770-8503, Japan

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Department of Neurology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan

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Division of Rehabilitation, Tokushima University Hospital, Tokushima University, Tokushima 770-8503, Japan

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Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan

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Department of Radiology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan

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Department of Neurodegenerative Disorders Research, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan

Author to whom correspondence should be addressed.

Brain Sci. 2020, 10(9), 636; https://doi.org/10.3390/brainsci10090636

Received: 8 August 2020 / Revised: 29 August 2020 / Accepted: 11 September 2020 / Published: 15 September 2020

(This article belongs to the Special Issue Collection on Clinical Neuroscience)

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Abstract

The diagnosis and treatment of functional movement disorders are challenging for clinicians who manage patients with movement disorders. The borderline between functional and organic dystonia is often ambiguous. Patients with functional dystonia are poor responders to pallidal deep brain stimulation (DBS) and are not good candidates for DBS surgery. Thus, if patients with medically refractory dystonia have functional features, they are usually left untreated with DBS surgery. In order to investigate the outcome of functional dystonia in response to pallidal DBS surgery, we retrospectively included five patients with this condition. Their dystonia was diagnosed as organic by dystonia specialists and also as functional according to the Fahn and Williams criteria or the Gupta and Lang Proposed Revisions. Microelectrode recordings in the globus pallidus internus of all patients showed a cell-firing pattern of bursting with interburst intervals, which is considered typical of organic dystonia. Although their clinical course after DBS surgery was incongruent to organic dystonia, the outcome was good. Our results question the possibility to clearly differentiate functional dystonia from organic dystonia. We hypothesized that functional dystonia can coexist with organic dystonia, and that medically intractable dystonia with combined functional and organic features can be successfully treated by DBS surgery. View Full-Text

Keywords: dystonia disorder; movement disorders; somatoform disorder; deep brain stimulation; neuronal plasticity

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MDPI and ACS Style

Morigaki, R.; Miyamoto, R.; Mure, H.; Fujita, K.; Matsuda, T.; Yamamoto, Y.; Nakataki, M.; Okahisa, T.; Matsumoto, Y.; Miyake, K.; Yamamoto, N.; Kaji, R.; Takagi, Y.; Goto, S. Can Pallidal Deep Brain Stimulation Rescue Borderline Dystonia? Possible Coexistence of Functional (Psychogenic) and Organic Components. Brain Sci. 2020, 10, 636. https://doi.org/10.3390/brainsci10090636

AMA Style

Morigaki R, Miyamoto R, Mure H, Fujita K, Matsuda T, Yamamoto Y, Nakataki M, Okahisa T, Matsumoto Y, Miyake K, Yamamoto N, Kaji R, Takagi Y, Goto S. Can Pallidal Deep Brain Stimulation Rescue Borderline Dystonia? Possible Coexistence of Functional (Psychogenic) and Organic Components. Brain Sciences. 2020; 10(9):636. https://doi.org/10.3390/brainsci10090636

Chicago/Turabian Style

Morigaki, Ryoma, Ryosuke Miyamoto, Hideo Mure, Koji Fujita, Taku Matsuda, Yoko Yamamoto, Masahito Nakataki, Tetsuya Okahisa, Yuki Matsumoto, Kazuhisa Miyake, Nobuaki Yamamoto, Ryuji Kaji, Yasushi Takagi, and Satoshi Goto. 2020. "Can Pallidal Deep Brain Stimulation Rescue Borderline Dystonia? Possible Coexistence of Functional (Psychogenic) and Organic Components" Brain Sciences 10, no. 9: 636. https://doi.org/10.3390/brainsci10090636

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Can Pallidal Deep Brain Stimulation Rescue Borderline Dystonia? Possible Coexistence of Functional (Psychogenic) and Organic Components

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