Pallidal stimulation for dystonia.
OBJECTIVE
High-frequency deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a new and promising treatment option for severe dystonia. Yet only few studies have been published to date regarding this treatment. We present the results of DBS of the GPi in 17 patients with severe dystonia of different causes.


METHODS
In our study, we included 10 patients with primary generalized dystonia, six patients with secondary generalized dystonia, and one patient with a severe dystonic cervical tremor. In all patients, DBS electrodes were implanted bilaterally within the GPi. Mean follow-up time was 36 months (range, 12-66 mo). Preoperative and postoperative evaluations (at least annually) were performed using the Burk-Fahn-Marsden scale.


RESULTS
The best improvement was achieved in patients with DYT1-positive dystonia. Patients with DYT1-negative generalized dystonia showed inhomogeneous results. There was no significant change in patients with tardive dystonia. One case of Hallervorden-Spatz disease improved dramatically within the first 2 years. The improvement in the cervical dystonic tremor was disappointing, however. Three years after DBS implantation, we found a secondary worsening of symptoms in one patient with a DYT1-positive dystonia and in the patient with Hallervorden-Spatz disease.


CONCLUSIONS
DBS of the GPi is a new and promising treatment option for dystonia. Secondary worsening may limit this therapy.
Krause
Martin
M
Department of Neurology, University of Heidelberg, 69120 Heidelberg, Germany. martin_krause@med.uni-heidelberg.de
Fogel
Wolfgang
W
Kloss
Manja
M
Rasche
Dirk
D
Volkmann
Jens
J
Tronnier
Volker
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D004421:Dystonia / Q000601:surgery*; D005260:Female; D005917:Globus Pallidus / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*