Editorial: Advances in Invasive and Non-invasive Brain Stimulation for Dystonia and Other Hyperkinetic Movement Disorders
Year: 2021
Type: editorial
Abstract: Research endeavors the last decade focus on invasive and non-invasive treatments of dystonia and other hyperkinetic movement disorders. However, research outcomes are often limited by their clinical and genetic heterogeneity, the small sample size and lack of neurophysiological biomarkers compared to Parkinson's Disease (1). In this collection, a range of exciting advances in invasive and non-invasive stimulation for the hyperkinetic movement disorders are showcased.A review by Tisch and Kumar overviews globus pallidus deep brain stimulation (DBS) for the monogenic dystonias (2). Factors that contribute to variability of outcome are succinctly summarised and long-term outcomes across the different genetic dystonias (both isolated and combined) are critically appraised. The resultant clinical roadmap of the effect on gene over DBS provides an informative guide to best clinical practice in the monogenic dystonias. For example, good outcomes following GPi DBS have been documented in X-linked dystonia Parkinsonism (DYT3), whereas poorer, more variable results have been reported in DYT-THAP1 (DYT6).Research articles and case histories also illustrate the expanding number of parameters to consider within the optimisation of deep brain surgery. Eleopra retrospectively compares frame-based versus frameless neurosurgery in twenty patients with dystonia, suggesting that the newer frameless technique is safe, of comparable efficacy to frame-based surgery and patients' comfort during awake surgery (3). Neuroanatomically, much research exploring an expanding network implicated in dystonia and tremor has highlighted an important role for the cerebellum. Horisawa and co-workers detail a rare case in which deep cerebellar stimulation has been recently used after failure of alternative functional neurosurgeries (4).With contacts extending from the superior cerebellar peduncle to the dentate nuclei almost compete resolution of symptoms was achieved with deep cerebellar stimulation highlighting its potential as a treatment for both tremor and dystonia. Fu similarly expands the neuroanatomical network amenable to therapeutic stimulation in Tourette's syndrome (5).This study examined the effect of bilateral parietal cortex low-frequency repetitive transcranial magnetic with improvements in tic severity and premonitory urges seen both at the end of the ten days treatment and maintained at one month. Prenassi and colleagues then put the focus of attention on dyskinesia in Parkinson's disease (6). They probe the observation that amplitude-controlled adaptive DBS can significantly reduce total amount of electrical energy delivered to the brain and show that dyskinesia was reduced when patients receive this adaptive stimulation versus continuous DBS. The correlation between total electrical energy delivered and the quanta of dyskinesia experience by patients therefore further supports the use of adaptive paradigms to improve patient outcomes.A common theme is the expansion of the variety and options for stimulation in hyperkinetic movement disorders. A review by Latorre showcases the this diversity, discussing features that can be extracted from oscillatory activity of the central nervous system and the manner by which such information can be integrated with brain stimulation (1). They then shift their focus to the periphery using tremor and Tourette's syndrome to illustrate the utility of peripheral biomarkers and interventions. Finally, the review focuses on current innovations which are changing the landscape of stimulation strategy such as technological advances and the use of machine learning to drive optimization. Correspondingly, Bashir provides advice for how we can evaluate novel deep learning methods (7). The Authors suggest that all new methods require a comparative justification to other state of the art methods that goes beyond the overall accuracy of prediction. They identify computational efficiency and the prediction time for a learning model as core metrics and call for greater detail to be shared within methods so that the broader parameters of models are available for evaluation.There is therefore much optimism that novel methods of analysis and neural stimulation will transform the management of hyperkinetic movement disorders over the next few decades. This collection of articles provides a range of material; solid reference resources, novel data and opinions from leaders in the field, that can be collectively used to optimise therapeutic options for this diverse collection of movement disorders.
Source: Frontiers in Neurology
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,950
OpenAlex ID: W3193302152