Journal of Neurology

, Volume 258, Issue 11, pp 2069–2074

Mixed results for GPi-DBS in the treatment of cranio-facial and cranio-cervical dystonia symptoms

  • Natlada Limotai
  • Criscely Go
  • Genko Oyama
  • Nelson Hwynn
  • Theresa Zesiewicz
  • Kelly Foote
  • Roongroj Bhidayasiri
  • Irene Malaty
  • Pam Zeilman
  • Ramon Rodriguez
  • Michael S. Okun
Original Communication

DOI: 10.1007/s00415-011-6075-0

Cite this article as:
Limotai, N., Go, C., Oyama, G. et al. J Neurol (2011) 258: 2069. doi:10.1007/s00415-011-6075-0

Abstract

The aim of the study is to determine clinical outcomes in patients undergoing Globus Pallidus Internus Deep Brain Stimulation (GPi-DBS) for cranio-facial and cranio-cervical dystonia (Meige) symptoms. A total of 6 patients seen between 2002 and 2010 with cranio-facial and cranio-cervical dystonia symptoms were identified from the University of Florida Institutional Review Board approved database. Patients were videotaped using a standardized protocol, and tapes were randomized and blindly reviewed by a movement disorders neurologist. The Unified Dystonia Rating Scale improved 31.6 ± 23.2% (range: 3.4–63.2%) at 6 months and 63.7 ± 35.3% (range: 6.3–100%) at 12 months. The Burke–Fahn–Marsden Dystonia Rating Scale improved 45.3 ± 29.5% (range: 4.7–75.0%) at 6 months and 61.8 ± 30.9% (range: 16.6–100%) at 12 months. One patient significantly had a very large improvement with little evidence of residual dystonia. Blepharospasm improved in all patients, whereas speech and swallowing did not improve in this cohort. Two patients improved with unilateral GPi-DBS, although one required a contralateral DBS later in the disease course. Two patients were managed with low frequency stimulation (<100 Hz). Two patients had less than 20% benefit. GPi-DBS for cranio-facial and cranio-cervical symptoms is an effective strategy to manage a subset of patients who remain unresponsive to optimized medical management. Unilateral stimulation may be an option for some patients, but it remains unclear whether response to single-sided stimulation will be sustainable. The mixed results of this GPi-DBS case series highlight the need for a careful re-examination of selection criteria, alternative brain targets, and possibly rescue leads for patients who are non-responders to the GPi target.

Keywords

Pallidum Segmental Frequency Outcome Meige 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Natlada Limotai
    • 1
    • 3
  • Criscely Go
    • 1
  • Genko Oyama
    • 1
  • Nelson Hwynn
    • 1
  • Theresa Zesiewicz
    • 2
  • Kelly Foote
    • 1
  • Roongroj Bhidayasiri
    • 3
  • Irene Malaty
    • 1
  • Pam Zeilman
    • 1
  • Ramon Rodriguez
    • 1
  • Michael S. Okun
    • 1
  1. 1.Department of Neurology, Center for Movement Disorders and NeurorestorationUniversity of FloridaGainesvilleUSA
  2. 2.Department of Neurology, College of Medicine TampaUniversity of South Florida HealthTampaUSA
  3. 3.Chulalongkorn Comprehensive Movement Disorders Center, Chulalongkorn University Hospital, Thai Red Cross SocietyBangkokThailand

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