The Canadian multicenter trial of pallidal deep brain stimulation for cervical dystonia: preliminary results in three patients.
OBJECTIVE
Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is beneficial for generalized dystonia and has been proposed as a treatment for cervical dystonia. The Canadian Stereotactic/Functional and Movement Disorders Groups designed a pilot project to investigate the following hypothesis: that bilateral DBS of the GPi will reduce the severity of cervical dystonia at 1 year of follow up, as scored in a blinded fashion by two neurologists using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Secondary outcome measures included pain and disability subscores of the TWSTRS, Short Form-36 quality of life index, and the Beck Depression Inventory.


METHODS
Three patients have undergone surgery in Calgary with a follow-up duration of 7.4 +/- 5.9 months (mean +/- standard deviation). One patient underwent inadvertent ineffective stimulation for the first 3 months and did not experience a benefit until DBS programming was corrected. All three patients had rapid response to stimulation, with the muscles relaxing immediately and abnormal movements improving within days. Total TWSTRS scores improved by 79%, and severity subscores improved significantly, from 15.7 +/- 2.1 to 7.7 +/- 2.9 (paired t-test, p = 0.02). Pain and disability subscores improved from 25.5 +/- 4.1 to 3.3 +/- 3.1 (paired t-test, p = 0.002) and from 13.3 +/- 4.9 to 3.3 +/- 4.2 (paired t-test, p = 0.06), respectively.


CONCLUSIONS
Although it is too early to reach broad conclusions, this report of preliminary results confirms the efficacy of DBS of the GPi for cervical dystonia.
Kiss
Zelma H
ZH
Department of Clinical Neuroscience, University of Calgary, Alberta, Canada. zkiss@ucalgary.ca
Doig
Kristina
K
Eliasziw
Michael
M
Ranawaya
Ranjiit
R
Suchowersky
Oksana
O
D000639:Amitriptyline / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D002188:Cannabis; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004401:Dysarthria / Q000209:etiology / Q000628:therapy; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005260:Female; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D007783:Lactones / Q000627:therapeutic use; D008140:Lorazepam / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use; D019051:Rhizotomy; D013450:Sulfones; D014103:Torticollis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
D007783:Lactones; D013450:Sulfones; C116926:rofecoxib; D000639:Amitriptyline; D011433:Propranolol; D001905:Botulinum Toxins; D008140:Lorazepam