Deep brain stimulation for dystonia: patient selection and outcomes

• Published in: European journal of neurology Vol. 17; no. s1; pp. 102 - 106
• Main Authors: Speelman, J. D., Contarino, M. F., Schuurman, P. R., Tijssen, M. A. J., De Bie, R. M. A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2010
• Subjects: deep brain stimulation; Deep Brain Stimulation - economics; Deep Brain Stimulation - methods; Dystonia - classification; Dystonia - economics; Dystonia - therapy; dystonias; globus pallidus; Globus Pallidus - physiology; Humans; Patient Selection; predictors of outcome; Retrospective Studies; Treatment Outcome
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/j.1468-1331.2010.03060.x

In a literature survey, 341 patients with primary and 109 with secondary dystonias treated with deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) were identified. In general, the outcomes for primary dystonias were more favourable compared to the secondary forms. For some secondary dystonias – like tardive dystonia, myoclonus‐dystonia (M‐D), NBIA (PANK2), the outcome was very good. Only for the primary generalized dystonias, the efficacy of GPi‐DBS has been confirmed in randomised controlled trials. Predictors of outcome are the experience and dedication of the stereotactic team, the selection of patients – the diagnosis and pre‐operative screening – and the quality of the post‐operative care. Predictors of negative outcome are long duration of the disease – with contractures or scoliosis – and concomitant symptoms like spasticity and cerebellar dysfunction. More studies are required to establish the role of GPi‐DBS in the treatment of secondary dystonias.