Deep Brain Stimulation at Mayo Clinic Provides Dramatic
Results for Dystonia Patients

Tuesday, March 30, 2004

Media Contact:
Lynn Closway
Mayo Clinic
480-301-4222
closway.lynn@mayo.edu

For Immediate Release - March 30, 2004

SCOTTSDALE, Ariz. - Neurologists at Mayo Clinic in Scottsdale now perform Deep Brain Stimulation (DBS), a procedure to evoke significant improvement in patients with a genetic form of dystonia called lubag. This is the first time in the world this procedure has been done for lubag, a neurological condition that affects many men and occasionally females of Philippine descent.

Dystonia is a neurological movement disorder characterized by involuntary muscle contractions that force certain parts of the body into abnormal, sometimes painful, movements or postures. Dystonia can affect any part of the body including the arms and legs, trunk, neck, eyelids, face or vocal cords.

Lubag is a form of dystonia that occurs in about one of every 4,000 men in the southern part of the Philippines. It may be misdiagnosed as Parkinson's disease or essential tremor, and Mayo Clinic researchers theorize it may occur in populations other than Filipinos.

Deep brain stimulation (DBS) surgery involves implanting electrodes into the brain and stimulating certain deep brain nuclei with pulse generators that help correct abnormal brain circuits and alleviate symptoms of these neurological conditions. Unlike brain lesioning procedures (burning or radiation) that are permanent, non-adjustable and irreversible, DBS does not destroy any brain structure and allows the option of future revisions or adjustments.

"We've been highly successfully using DBS for Parkinson's disease and essential tremor since starting the program two years ago," says Virgilio Evidente, M.D., neurologist at Mayo Clinic. "Dystonia however is a totally different disorder with a different deep brain nuclear target. We were surprised and pleased to see such early positive results and significant improvement in our lubag patients in just two weeks post-surgery since experience on other forms of dystonia shows the clinical response to DBS is delayed for 6 to 12 months in most patients."

During deep brain stimulation surgery, brain mapping is used to find the targeted nucleus by recording the brain wave characteristics at different depths and trajectories, and observing the patient's response to stimulation. This mapping allows the surgeon to precisely pinpoint the correct area to place the electrodes and to minimize any unwanted side effects. The DBS program at Mayo Clinic utilizes the five microelectrode system to simultaneously record the brain wave activity. This technique greatly shortens the length of the surgery and may increase the accuracy of the procedure.

Patients are awake, under minimal sedation, so they can verbalize side effects from stimulation. Unique to Mayo Clinic, acupuncture is used to alleviate anxiety and pain during the procedure in order to minimize the amount of sedatives and anesthetics the patient receives. DBS usually takes about three to four hours and patients typically stay in the hospital for one to two days. Pulse generators are placed beneath the patient's clavicle and are programmed one week following the surgery.

"We're seeing such encouraging results with DBS, and are able to make a dramatic difference in the lives of patients not only with dystonia, but also with advanced Parkinson's disease and severe essential tremor," says Dr. Evidente. "Hopefully, we will be able to offer DBS for other movement disorders in the future."

He adds, "In my opinion, DBS involves not only science but art. At Mayo Clinic, we've developed our own process and style in performing the procedure and programming after surgery. Our multidisciplinary team is continually looking for innovative ways to improve on this technology and to produce optimal overall results in our patients."

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