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Deep brain stimulation in Huntington’s disease: a literature review

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Abstract

Background

Huntington’s disease (HD) is a neurodegenerative disorder characterized by involuntary movements, cognitive decline, and behavioral changes. The complex constellation of clinical symptoms still makes the therapeutic management challenging. In the new era of functional neurosurgery, deep brain stimulation (DBS) may represent a promising therapeutic approach in selected HD patients.

Methods

Articles describing the effect of DBS in patients affected by HD were selected from Medline and PubMed by the association of text words with MeSH terms as follows: “Deep brain stimulation,” “DBS,” and “HD,” “Huntington’s disease,” and “Huntington.” Details on repeat expansion, age at operation, target of operation, duration of follow-up, stimulation parameters, adverse events, and outcome measures were collected.

Results

Twenty eligible studies, assessing 42 patients with HD, were identified. The effect of globus pallidus internus (GPi) DBS on Unified Huntington’s Disease Rating Scale (UHDRS) total score revealed in 10 studies an improvement of total score from 5.4 to 34.5%, and in 4 studies, an increase of motor score from 3.8 to 97.8%. Bilateral GPi-DBS was reported to be effective in reducing Chorea subscore in all studies, with a mean percentage reduction from 21.4 to 73.6%.

Conclusions

HD patients with predominant choreic symptoms may be the best candidates for surgery, but the role of other clinical features and of disease progression should be elucidated. For this reason, there is a need for more reliable criteria that may guide the selection of HD patients suitable for DBS. Accordingly, further studies including functional outcomes as primary endpoints are needed.

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Author notes

  1. Roberta Bonomo and Antonio E. Elia have contributed equally to this work and share first authorship

Authors and Affiliations

  1. Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, Italy

    Roberta Bonomo, Antonio E. Elia, Luigi M. Romito, Grazia Devigili, Roberto Cilia & Roberto Eleopra

  2. Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Roberta Bonomo

  3. Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

    Giulio Bonomo

  4. Unit of Medical Genetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

    Caterina Mariotti

  5. Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

    Riccardo Giossi

  6. Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy

    Riccardo Giossi

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  1. Roberta Bonomo
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Bonomo, R., Elia, A.E., Bonomo, G. et al. Deep brain stimulation in Huntington’s disease: a literature review. Neurol Sci 42, 4447–4457 (2021). https://doi.org/10.1007/s10072-021-05527-1

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