Bilateral pallidotomy for generalized dystonia.
OBJECTIVE
To evaluate the efficacy and safety of bilateral pallidotomies in five patients with generalized dystonia.


BACKGROUND
Generalized dystonias are frequently a therapeutic challenge, with poor responses to pharmacological treatment. GPi (globus pallidus internus) pallidotomies for Parkinson's disease ameliorate all kinds of dyskinesias/dystonia, and recent studies reported a marked improvement of refractory dystonias with this procedure.


METHODS
Five patients with generalized dystonias refractory to medical treatment were selected; one posttraumatic and four idiopathic. The decision to perform bilateral procedures was based on the predominant axial involvement in these patients. Dystonia severity was assessed with the Burke-Fahn-Marsden Dystonia Scale (BFM). Simultaneous procedures were performed in all but one patient, who had a staged procedure. They were reevaluated with the same scale (BFM) by an unblinded rater at 1, 2, 3, 30, 60, 90, 120 and 180 days post-operatively.


RESULTS
The four patients with idiopathic dystonia showed a progressive improvement up to three months; the patient with posttraumatic dystonia relapsed at three months. One patient had a marked improvement, being able to discontinue all the medications. A mean decrease in the BFM scores of 52,58% was noted. One patient had a trans-operative motor seizure followed by a transient hemiparesis secondary to rack hemorrhage; other was lethargic up to three days after the procedure.


CONCLUSIONS
Our results show that bilateral GPi pallidotomies may be a safe and effective approach to medically refractory generalized dystonias; it can also be speculated that the posttraumatic subgroup may not benefit with this procedure.
Teive
H A
HA
Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, PR, Brazil. hagteive@@mps.com.br
Sá
D S
DS
Grande
C V
CV
Antoniuk
A
A
Werneck
L C
LC
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D004421:Dystonia / Q000601:surgery*; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D013238:Stereotaxic Techniques; D016896:Treatment Outcome