title: Successful bilateral subthalamic nucleus stimulation for segmental dystonia after unilateral pallidotomy.
abstract: BACKGROUND
  Several subcortical structures have been targeted for surgical treatment of dystonia, including motor thalamus, internal segment of globus pallidus (GPi), and more recently, the subthalamic nucleus (STN). Deep brain stimulation of GPi is currently the preferred surgical treatment, but it is unclear if targeting other structures would yield better results. Patients who have already had a pallidotomy yet continue to experience dystonic symptoms may be limited in further treatment options.
  
  
  METHODS
  A patient with medically intractable, segmental, early-onset, primary torsion dystonia presented for surgical consultation after exhausting nearly all treatment options. Medications, botulinum toxin injections, cervical denervation surgery, and left-sided pallidotomy failed to give adequate relief. The patient was implanted with STN stimulating leads bilaterally according to standard procedures.
  
  
  RESULTS
  The patient received a 36% improvement in dystonic symptoms as measured by several dystonia rating scales. These benefits persisted for 2 years after surgery despite several hardware-related complications, and the patient reported being very satisfied with the outcome.
  
  
  CONCLUSIONS
  This result supports the efficacy of STN deep brain stimulation in dystonia patients, even those with prior pallidotomy.
authors: Department of Neurology, Evanston Northwestern Healthcare, Evanston, IL 60201, USA.
authors: Kevin E
authors: KE
authors: Novak
authors: Emmanuel K
authors: EK
authors: Nenonene
authors: Lawrence P
authors: LP
authors: Bernstein
authors: Sandra
authors: S
authors: Vergenz
authors: Jeffrey W
authors: JW
authors: Cozzens
authors: Michael
authors: M
authors: Rezak
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D004421:Dystonia / Q000503:physiopathology* / Q000628:therapy*; D005917:Globus Pallidus / Q000601:surgery; D006801:Humans; D008297:Male; D053860:Pallidotomy / Q000379:methods*; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology* / Q000601:surgery