Bradykinesia induced by pallidal neurostimulation in dystonia: clinical risk factors and anatomical mapping
Pallidal deep brain stimulation (DBS) for dystonia can induce bradykinesia. We analyzed retrospective (n = 55) and prospective (n = 11) cohorts to identify risks and anatomical substrates for this side effect. Bradykinesia was prevalent (60-72%), with female sex, older dystonia onset, shorter disease duration, and crucially, stimulation pulse width identified as key predictive factors. Probabilistic mapping isolated a posterolateral globus pallidus internus "sour spot" for bradykinesia, which was spatially distinct from therapeutic "sweet spots" and demonstrated patient-level predictive power in cross-validation (R² = 0.16, p = 0.0013). Kinematic analysis showed reducing stimulation selectively improved movement frequency without altering amplitude. The effect appears mediated by local grey-matter modulation, not major white matter tracts. These findings suggest programming strategies using shorter pulse widths while avoiding the identified sour spot can mitigate bradykinesia without sacrificing antidystonic benefit.
Authors
- Andrea A. Kühn (ORCID: https://orcid.org/0000-0002-4134-9060)
- Florian Lange (ORCID: https://orcid.org/0000-0001-8497-7780)
- Diego L. Guarín (ORCID: https://orcid.org/0000-0001-6077-7063)
- Christine Daniels (ORCID: https://orcid.org/0000-0003-0368-0438)
- Benedikt Weigl
- Martin M. Reich (ORCID: https://orcid.org/0000-0001-9115-5136)
- Jonas Roothans (ORCID: https://orcid.org/0000-0001-6694-116X)
- Jens Volkmann (ORCID: https://orcid.org/0000-0002-9570-593X)
- Günther Deuschl (ORCID: https://orcid.org/0000-0002-4176-9196)
- Robert L. Peach (ORCID: https://orcid.org/0000-0002-8738-5825)
- Thorsten Odorfer (ORCID: https://orcid.org/0000-0001-9042-7689)
- Philipp Mahlknecht (ORCID: https://orcid.org/0000-0003-0671-0516)
- Joachim K. Krauss (ORCID: https://orcid.org/0000-0002-0675-9064)
- Gregor A. Brandt (ORCID: https://orcid.org/0000-0002-9984-2069)
- Joachim Runge
- Pavel Navratil
- Stella Mosert
- Berenike Karrasch
Institutions
- Innsbruck Medical University (AT)
- University of Würzburg (DE)
- Christian-Albrechts-Universität zu Kiel (DE)
- University of Florida (US)
- Medizinische Hochschule Hannover (DE)
- University Hospital Cologne (DE)
- Imperial College London (GB)
- Charité - Universitätsmedizin Berlin (DE)
Publication Details
- Journal
- npj Parkinson s Disease
- Published
- 2025-10-23
- DOI
- https://doi.org/10.1038/s41531-025-01177-8
- Citations
- 1
- Primary Topic
- Neurological disorders and treatments
- Type
- article
- Field-Weighted Citation Impact
- 1.39
Funders
- Deutsche Forschungsgemeinschaft
- Interdisziplinäres Zentrum für Klinische Forschung, Universitätsklinikum Würzburg