Pallidal stimulation for segmental dystonia: long term follow up of 11 consecutive patients.
Pallidal stimulation is a convincing and valid alternative for primary generalized dystonia refractory to medical therapy or botulinum toxin. However, the clinical outcome reported in literature is variable most likely because of heterogeneity DBS techniques employed and /or to clinical dystonic pattern of the patients who undergo surgery. In this study, we report the long term follow up of a homogeneous group of eleven subjects affected by segmental dystonia who were treated with bilateral stimulation of the Globus Pallidus pars interna (GPi) from the years 2000 to 2008. All the patients were evaluated, before surgery and at 6-12-24-36 months after the treatment, in accordance with the Burke Fahn Marsden Dystonia Rating Scale (BFMDRS). Our study indicates that DBS promotes an early and significant improvement at 6 months with an even and a better outcome later on. The analysis of specific sub items of the BFMDRS revealed an earlier and striking benefit not only as far as segmental motor function of the limbs but also for the complex cranial functions like face, (eyes and mouth), speech and swallowing, differently from results reported in primary generalized dystonia. Deep Brain Stimulation of GPi should be considered a valid indication for both generalized and segmental dystonia when other therapies appear ineffective.
Sensi
Mariachiara
M
Department of Neuroscience, S. Anna University Hospital of Ferrara, Ferrara, Italy. chiasen@lycos.com
Cavallo
Michele A
MA
Quatrale
Rocco
R
Sarubbo
Silvio
S
Biguzzi
Sara
S
Lettieri
Cristian
C
Capone
Jay G
JG
Tugnoli
Valeria
V
Tola
Maria Rosaria
MR
Eleopra
Roberto
R
D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D004185:Disability Evaluation; D020821:Dystonic Disorders / Q000235:genetics / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D007839:Functional Laterality; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D018832:Molecular Chaperones / Q000235:genetics; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D018832:Molecular Chaperones; C108175:TOR1A protein, human