Abstract
Objective
Deep brain stimulation (DBS) has emerged as a useful therapeutic option for patients with insufficient benefit from conservative treatment.
Methods
Nine patients with chronic DBS who suffered from cervical dystonia (4), generalized dystonia (2), hemidystonia (1), paroxysmal dystonia (1) and Meige syndrome (1) were available for formal follow-up at three years postoperatively, and beyond up to 10 years. All patients had undergone pallidal stimulation except one patient with paroxysmal dystonia who underwent thalamic stimulation.
Results
Maintained improvement was seen in all patients with pallidal stimulation up to 10 years after surgery except in one patient who had a relative loss of benefit in dystonia ratings but continued to have improved disability scores. After nine years of chronic thalamic stimulation there was a mild loss of efficacy which was regained when the target was changed to the pallidum in the patient with paroxysmal dystonia. There were no major complications related to surgery or to chronic stimulation. Pacemakers had to be replaced within 1.5 to 2 years, in general.
Conclusion
DBS maintains marked long-term symptomatic and functional improvement in the majority of patients with dystonia.
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References
Albanese A, Barnes MP, Bhatia KP, Fernandez-Alvarez E, Filippini G, Gasser T, et al. (2006) A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task Force. Eur J Neurol 13:433–444
Bittar RG, Yianni J, Wang S, Liu X, Nandi D, Joint C, et al. (2005) Deep brain stimulation for generalised dystonia and spasmodic torticollis. J Clin Neurosci 12:12–16
Capelle HH, Weigel R, Krauss JK (2003) Bilateral pallidal stimulation for blepharospasm-oromandibular dystonia (Meige syndrome). Neurology 60:2017–2018
Coubes P, Cif L, El Fertit H, Hemm S, Vayssiere N, Serrat S, et al. (2004) Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: longterm results. J Neurosurg 101:189–194
Diamond A, Shahed J, Azher S, Dat-Vuong K, Jankovic J (2006) Globus pallidus deep brain stimulation in dystonia. Mov Disord 21:692–695
Eltahawy HA, Saint-Cyr J, Giladi N, Lang AE, Lozano AM (2004) Primary dystonia is more responsive than secondary dystonia to pallidal interventions: outcome after pallidotomy or pallidal deep brain stimulation. Neurosurgery 54:613–619
Grips E, Blahak C, Capelle HH, Bäzner H, Weigel R, Sedlaczek O, et al. (2007) Patterns of reoccurrence of segmental dystonia after discontinuation of deep brain stimulation. J Neurol Neurosurg Psychiatry 78:318–320
Krauss JK, Pohle T, Weber S, Ozdoba C, Burgunder JM (1999) Bilateral stimulation of globus pallidus internus for treatment of cervical dystonia. Lancet 354:837–838
Krauss JK, Loher TJ, Weigel R, Capelle HH, Weber S, Burgunder JM (2002) Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy. J Neurol Neurosurg Psychiatry 72:249–256
Krauss JK, Loher TJ, Weigel R, Capelle HH, Weber S, Burgunder JM (2003) Chronic stimulation of the globus pallidus internus for treatment of non- DYT1 generalized dystonia and choreoathetosis: 2-year follow up. J Neurosurg 98:785–792
Krauss JK, Yianni J, Loher TJ, Aziz TZ (2004) Deep brain stimulation for dystonia. J Clin Neurophysiol 21:18–30
Kupsch A, Benecke R, Müller J, Trottenberg T, Schneider GH, Poewe W, et al. (2006) Deep-Brain Stimulation for Dystonia Study Group. Pallidal deepbrain stimulation in primary generalized or segmental dystonia. N Engl J Med 355:1978–1990
Loher TJ, Hasdemir MG, Burgunder JM, Krauss JK (2000) Long-term follow- up study of chronic globus pallidus internus stimulation for posttraumatic hemidystonia. J Neurosurg 92:457–460
Loher TJ, Krauss JK, Burgunder JM, Taub E, Siegfried J (2001) Chronic thalamic stimulation for treatment of dystonic paroxysmal nonkinesigenic dyskinesia. Neurology 56:268–270
Loher TJ, Barlocher CB, Krauss JK (2006) Dystonic movement disorders and spinal degenerative disease. Stereotact Funct Neurosurg 84:1–11
Opherk C, Gruber C, Steude U, Dichgans M, Botzel K (2006) Successful bilateral pallidal stimulation for Meige syndrome and spasmodic torticollis. Neurology 66:E14
Starr PA, Turner RS, Rau G, Lindsey N, Heath S, Volz M, et al. (2006) Microelectrode- guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes. J Neurosurg 104:488–501
Vercueil L, Pollak P, Fraix V, Caputo E, Moro E, Benazzouz A, et al. (2001) Deep brain stimulation in the treatment of severe dystonia. J Neurol 248:695–700
Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Benabid AL, Cornu P, et al. (2005) French Stimulation du Pallidum Interne dans la Dystonie (SPIDY) Study Group. Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. N Engl J Med 352:459–467
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Loher, T.J., Capelle, HH., Kaelin-Lang, A. et al. Deep brain stimulation for dystonia: outcome at long-term follow-up. J Neurol 255, 881–884 (2008). https://doi.org/10.1007/s00415-008-0798-6
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DOI: https://doi.org/10.1007/s00415-008-0798-6