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Selective peripheral denervation: comparison with pallidal stimulation and literature review

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Abstract

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.

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Acknowledgments

The authors wish to thank the movement disorders nurses M. Postma, M. Scholten, and G. Iwan for assistance to the patients. No funding was obtained for this work.

Conflicts of interest

The DBS team of the AMC received unrestricted educational grants from Medtronic and received financial compensation for teaching courses for the European Continue Medical Training (ECMT). The Movement Disorders team of the AMC received an unrestricted grant from Ipsen. The Movement Disorders team of the UMCG received unrestricted grants from Ipsen, Allergan, and Medtronic. J.D. Speelman has acted as independent advisor for Medtronic and Ipsen Pharmaceuticals. P.R. Schuurman acts as independent advisor for Medtronic and Sapiens Steering Brain Stimulation.

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Authors and Affiliations

  1. Department of Neurology/Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Maria Fiorella Contarino, Marina A. J. Tijssen, Rob M. A. de Bie & Johannes D. Speelman

  2. Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Pepijn Van Den Munckhof, D. Andries Bosch & P. Richard Schuurman

  3. Department of Neurology, Haga Ziekenhuis Teaching Hospital, The Hague, The Netherlands

    Maria Fiorella Contarino

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  1. Maria Fiorella Contarino
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  2. Pepijn Van Den Munckhof
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  3. Marina A. J. Tijssen
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  4. Rob M. A. de Bie
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  7. Johannes D. Speelman
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Correspondence to Maria Fiorella Contarino.

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Contarino, M.F., Van Den Munckhof, P., Tijssen, M.A.J. et al. Selective peripheral denervation: comparison with pallidal stimulation and literature review. J Neurol 261, 300–308 (2014). https://doi.org/10.1007/s00415-013-7188-4

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  • DOI: https://doi.org/10.1007/s00415-013-7188-4

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