The promise of deep brain stimulation in X-linked dystonia parkinsonism

X-linked dystonia parkinsonism (XDP) is a rapidly progressive and disabling neurodegenerative disease affecting mainly male Filiponos with origins from Panay Island. We reviewed all the past neurosurgical ablative procedures done for XDP patients listed in the Philippine XDP registry. From 1960 to 1982, six patients had undergone bilateral chemopallidotomies or bilateral thalomotomies stage over time. Half of these patients had significant improvement in their symptoms but five of the six patients (83%) developed postoperative morbidities, mainly speech impairment or hemiparesis, All the five reported GPi deep brain stimulation (DBS) cases for XDP were also reviewed, showing consistently immediate improvement of symptoms (61.5%-88.3% decrease in the Burke-Marsden Dystonia Rating Scale) lasting up to a year with effects noted. We also present the first Philippine case of GPi DBS done in the youngest XDP patients to date. This present case showed dramatic improvement(83.3% desrease of the Burke-Marsden_Fahn Dystonia Rating Scale) of his dystonic symptoms, without incurring any persistent adverse effects. The results of these early cases of pallidal DBS for XDP show that DBS is generally a safe and effective procedure for alleviating the disabling symptoms of XDP in contrast to previous ablative surgeries on these patient

Management of non-motor symptoms in Parkinson's disease

It is now commonly accepted that non-motor symptoms of Parkinson's disease often outweigh and sometimes even antedate the development of motor symptoms of PD. It can prove to be more disabling and more challenging to treat and it clearly impacts quality of life in PD. This article provides a concise review of non-motor features in Parkinson's disease as well as the pathophysiological mechanisms underlying each complication. Currently available management strategies will be outlined as well.