Outcome of deep brain stimulation in slowly progressive multiple system atrophy: A clinico-pathological series and review of the literature

Wassilios G. Meissner, Chloé Laurencin, Christine Tranchant, Tatiana Witjas, François Viallet, Dominique Guehl, Philippe Damier, Jean-Luc Houeto, François Tison, Alexandre Eusebio, Anne Vital, Nathalie Streichenberger, Béatrice Lannes, André Maues de Paula, Stéphane Thobois
Parkinsonism & Related Disorders. 2016-03-01; 24: 69-75
DOI: 10.1016/j.parkreldis.2016.01.005

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1. Parkinsonism Relat Disord. 2016 Mar;24:69-75. doi:
10.1016/j.parkreldis.2016.01.005. Epub 2016 Jan 7.

Outcome of deep brain stimulation in slowly progressive multiple system atrophy:
A clinico-pathological series and review of the literature.

Meissner WG(1), Laurencin C(2), Tranchant C(3), Witjas T(4), Viallet F(5), Guehl
D(6), Damier P(7), Houeto JL(8), Tison F(1), Eusebio A(4), Vital A(9),
Streichenberger N(10), Lannes B(11), Maues de Paula A(12), Thobois S(13).

Author information:
(1)Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000
Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293,
F-33000 Bordeaux, France; Centre de référence atrophie multisystématisée, CHU de
Bordeaux, F-33076 Bordeaux, France.
(2)Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Expert
Parkinson’s Disease Center, 69000 Lyon, France; Université Lyon 1, Faculté de
Médecine Lyon Sud Charles Mérieux, 69000 Lyon, France; CNRS, Centre de
Neurosciences Cognitives, UMR5229, Bron, France.
(3)Service de Neurologie et FMTS, CHU Strasbourg, France.
(4)APHM, CHU Timone, Department of Neurology and Movement Disorders, and Institut
de Neurosciences de La Timone UMR 7289, Aix Marseille Université, CNRS, 13385,
Marseille, France.
(5)Service de Neurologie, CH intercommunal d’Aix-Pertuis, Laboratoire Parole et
Langage UMR 7309 CNRS et université Aix-Marseille, 13616 Aix en Provence, France.
(6)Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000
Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293,
F-33000 Bordeaux, France; Department of Clinical Neurophysiology, University
Hospital Bordeaux, France.
(7)Centre d’Investigation Clinique, Department of Neurology, CHU, INSERM, Nantes,
France.
(8)Service de Neurologie, CIC- INSERM 1402, CHU de Poitiers, Poitiers, France.
(9)Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000
Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293,
F-33000 Bordeaux, France; Department of Pathology, CHU, Bordeaux, France.
(10)Hospices Civils de Lyon, Groupement Hospitalier Est, Centre de Pathologie et
Neuropathologie Est, service de neuropathologie, Université Claude Bernard Lyon1,
CNRS UMR5239, LBMC, ENS, 69000, Lyon, France.
(11)Department of Pathology, CHU, Strasbourg, France.
(12)Department of Pathology, CHU, Marseille, France.
(13)Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Expert
Parkinson’s Disease Center, 69000 Lyon, France; Université Lyon 1, Faculté de
Médecine Lyon Sud Charles Mérieux, 69000 Lyon, France; CNRS, Centre de
Neurosciences Cognitives, UMR5229, Bron, France. Electronic address:
.

OBJECTIVES: To highlight the risk of clinical worsening after deep brain
stimulation in histologically proven multiple system atrophy (MSA) patients
presenting slow and relatively benign disease progression mimicking Parkinson’s
disease (PD). In such cases but also in more typical MSA patients, the results of
deep brain stimulation have been mostly reported as case reports and small
patient series.
METHODS: The present study describes the outcome of the largest series of
histologically proven MSA patients who underwent deep brain stimulation (DBS) of
the subthalamic nucleus because they were considered as having PD at the time of
surgery.
RESULTS: Three patients showed significant improvement of motor signs after
surgery while two did not. Clinical improvement was short-lasting and rapidly
followed by the occurrence of disabling manifestations of MSA that counteracted
DBS benefits.
CONCLUSIONS: Together with previous reports, our study demonstrates that DBS
should not be recommended for MSA patients. It also underlines that detecting
subtle red flags is crucial to avoid DBS surgery in this population.

Copyright © 2016 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.parkreldis.2016.01.005
PMID: 26778473 [Indexed for MEDLINE]

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