Clinical Article

Acta Neurochirurgica

, Volume 151, Issue 5, pp 473-478

Deep brain stimulation for secondary dystonia: results in 8 patients

  • P. F. KatsakioriAffiliated withFunctional Neurosurgery Unit, Department of Neurosurgery, School of Medicine, University of Patras
  • , Z. KefalopoulouAffiliated withFunctional Neurosurgery Unit, Department of Neurosurgery, School of Medicine, University of Patras
  • , E. MarkakiAffiliated withFunctional Neurosurgery Unit, Department of Neurosurgery, School of Medicine, University of Patras
  • , A. PaschaliAffiliated withFunctional Neurosurgery Unit, Department of Neurosurgery, School of Medicine, University of Patras
  • , J. EllulAffiliated withDepartment of Neurology, University of Patras
  • , G. C. KagadisAffiliated withDepartment of Medical Physics, University of Patras
  • , E. ChroniAffiliated withDepartment of Neurology, University of Patras
  • , C. ConstantoyannisAffiliated withFunctional Neurosurgery Unit, Department of Neurosurgery, School of Medicine, University of Patras Email author 

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Abstract

Background

Dystonia is a medically intractable condition characterized by involuntary twisting movements and/or abnormal postures. Deep Brain Stimulation (DBS) has been used successfully in various forms of dystonia. In the present study, we report on eight patients with secondary dystonia, treated with DBS in our clinic.

Method

Eight patients (five males, three females) underwent DBS for secondary dystonia. The etiology of dystonia was cerebral palsy (n = 2), drug-induced (n = 1), post encephalitis (n = 2) and postanoxic dystonia (n = 3). The functional capacity was evaluated before and after surgery with the use of Burke-Fahn-Mardsen Dystonia Rating Scale (BFM scale), both movement and disability scale (MS and DS, respectively). The target for DBS was the globus pallidus internus (GPi) in 7 patients and in one patient, with postanoxic damaged pallidum, the ventralis oralis anterior (Voa) nucleus. Brain perfusion scintigraphy using Single Photon Emission Computed Tomography (SPECT) was performed in two separate studies for each patient, one in the “off-DBS” and the other in the “on-DBS” state.

Findings

Postoperative both MS and DS scores were found to be significantly lower compared to preoperative scores (p = 0.018 and p = 0.039, respectively). Mean improvement rate after DBS was 41.4% (0 – 94.3) and 29.5% (0 – 84.2) in MS and DS scores, respectively. The SPECT Scan, during the “on-DBS” state, showed a decrease in regional cerebral blood flow (rCBF), compared to the “off-DBS” state.

Conclusions

Our results seem promising in the field of secondary dystonia treatment. More studies with greater number of patients and longer follow-up periods are necessary in order to establish the role of DBS in the management of secondary dystonia. Finally, the significance of brain SPECT imaging in the investigation of dystonia and functional effects of DBS should be further evaluated.

Keywords

Deep brain stimulation GPi Secondary dystonia Voa