Deep brain stimulation in dystonia.
Renewed interest in stereotaxy for dystonia followed the introduction of deep brain stimulation (DBS) in Parkinson's disease and essential tremor in the 1990s. DBS evolved from ablative surgery, which was applied with varying results in the 1950s in patients with movement disorders such as Parkinson's disease, essential tremor and dystonia. The present review summarizes the current knowledge on clinical aspects of DBS in dystonia (Dec. 2002). Excellent results have been achieved in dystonic patients carrying a mutation in the DYT1 gene with improvements up to 90 %. Similar results may also be obtained in patients with idiopathic generalized dystonia, myoclonus-dystonia syndrome, and tardive dystonia. Substantial improvement has been observed in patients with focal dystonia (for instance cervical dystonia). Patients with secondary dystonia often display a lesser and more variable degree of improvement. Long-term studies are warranted to assess both motor and neuropsychological sequelae of DBS in dystonia. Furthermore, the optimal target for different dystonic disorders remains to be determined, although the globus pallidus internus has currently emerged as the most promising target for dystonia.
Kupsch
Andreas
A
Dept. of Neurology and Neurosurgery, Augustenburger Platz 1, 13353 Berlin, Germany. andreas.kupsch@charite.de
Kuehn
Andrea
A
Klaffke
Stefanie
S
Meissner
Wassilios
W
Harnack
Daniel
D
Winter
Christine
C
Haelbig
Thomas D
TD
Kivi
Anatol
A
Arnold
Guy
G
Einhäupl
Karl-Max
KM
Schneider
Gerd-Helge
GH
Trottenberg
Thomas
T
D004421:Dystonia / Q000145:classification / Q000628:therapy*; D004558:Electric Stimulation; D004599:Electric Stimulation Therapy / Q000379:methods*; D005917:Globus Pallidus / Q000601:surgery; D006801:Humans; D013788:Thalamus / Q000601:surgery