Long-term benefit sustained after bilateral pallidal deep brain stimulation in patients with refractory tardive dystonia.
OBJECTIVE
Tardive dystonia (TD) can be a highly disabling, permanent condition related to the use of dopamine-receptor-blocking medications. Our aim was to evaluate the long-term effect of bilateral pallidal deep brain stimulation (DBS) for TD.


METHODS
Five consecutive patients with disabling TD who underwent stereotactic placement of bilateral globus pallidus internus DBS leads were included. All patients had a history of mood disorder or schizophrenia previously treated with neuroleptic medication, with a mean duration of motor symptoms of 10.2 years. Dystonia severity was measured using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) movement score by a blinded neurologist reviewing pre- and postoperative videotaped examinations.


RESULTS
The mean baseline movement BFMDRS score was 49.7 (range 20-88). Overall, we observed a mean reduction of 62% in the BFMDRS movement score within the first year after surgery. Persistent improvement in dystonia (71%) was seen at the last follow-up ranging from 2 to 8 years after surgery.


CONCLUSIONS
Our experience suggests that pallidal DBS can be an effective therapy with long-term benefits for patients with TD.
Chang
Edward F
EF
Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA. ChangEd@neurosurg.ucsf.edu
Schrock
Lauren E
LE
Starr
Philip A
PA
Ostrem
Jill L
JL
D000328:Adult; D046690:Deep Brain Stimulation; D018492:Dopamine Antagonists / Q000009:adverse effects*; D004409:Dyskinesia, Drug-Induced / Q000628:therapy*; D004567:Electrodes, Implanted; D005260:Female; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018492:Dopamine Antagonists