Journal of Neurology

, Volume 261, Issue 2, pp 300–308 | Cite as

Selective peripheral denervation: comparison with pallidal stimulation and literature review

  • Maria Fiorella Contarino
  • Pepijn Van Den Munckhof
  • Marina A. J. Tijssen
  • Rob M. A. de Bie
  • D. Andries Bosch
  • P. Richard Schuurman
  • Johannes D. Speelman
Original Communication


Patients with cervical dystonia who are non-responders to Botulinum toxin qualify for surgery. Selective peripheral denervation (Bertrand’s procedure, SPD) and deep brain stimulation of the globus pallidus (GPi-DBS) are available surgical options. Although peripheral denervation has potential advantages over DBS, the latter is nowadays more commonly performed. We describe the long-term outcome of selective peripheral denervation as compared with GPi-DBS, along with the findings of literature review. Twenty patients with selective peripheral denervation and 15 with GPi-DBS were included. Tsui scale, a visual analogue scale, and the global outcome score of the Toronto Western Spasmodic Torticollis Rating Scale were used to define a “combined global surgical outcome”. The “combined global surgical outcome” for patients with selective peripheral denervation or pallidal stimulation was respectively “bad” for 65 and 13.3 %, “fair-to-good” for 30 and 26.7 %, and “marked” improvement for 5 and 60 % (p < 0.001). Improvement on visual analogue scale (p < 0.002), global outcome score (p < 0.002), and Tsui score (p < 0.000) was larger for the pallidal stimulation group. Seventy-five percent of patients with selective peripheral denervation and 60 % of patients with pallidal stimulation reported side effects. Seven patients with selective peripheral denervation successively underwent GPi-DBS, with a further significant improvement in the Tsui score (−48.6 ± 17.4 %). GPi-DBS is to be preferred to selective peripheral denervation for the treatment of cervical dystonia because it produces larger benefit, even if it can have more potentially severe complications. GPi-DBS is also a valid alternative in case of failure of SPD.


Cervical dystonia Selective peripheral denervation Bertrand’s procedure Deep brain stimulation Globus pallidus 

Supplementary material

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Maria Fiorella Contarino
    • 1
    • 3
  • Pepijn Van Den Munckhof
    • 2
  • Marina A. J. Tijssen
    • 1
  • Rob M. A. de Bie
    • 1
  • D. Andries Bosch
    • 2
  • P. Richard Schuurman
    • 2
  • Johannes D. Speelman
    • 1
  1. 1.Department of Neurology/Clinical Neurophysiology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Neurosurgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Department of NeurologyHaga Ziekenhuis Teaching HospitalThe HagueThe Netherlands

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