title: Inclusion and exclusion criteria for DBS in dystonia.
abstract: When considering a patient with dystonia for deep brain stimulation (DBS) surgery several factors need to be considered. Level B evidence has shown that all motor features and associated pain in primary generalized and segmental dystonia are potentially responsive to globus pallidus internus (GPi) DBS. However, improvements in clinical series of ≥ 90% may reflect methods that need improvement, and larger prospective studies are needed to address these factors. Nevertheless, to date the selection criteria for DBS-specifically in terms of patient features (severity and nature of symptoms, age, time of evolution, or any other demographic or disease aspects)--have not been assessed in a systematic fashion. In general, dystonia patients are not considered for DBS unless medical therapies have been previously and extensively tested. The vast majority of reported patients have had DBS surgery when the disease was provoking important disability, with loss of independence and impaired quality of life. There does not appear to be an upper age limit or a minimum age limit, although there are no published data regarding the outcome of GPi DBS for dystonia in children younger than 7 years of age. There is currently no enough evidence to prove that subjects with primary--generalized dystonia who undergo DBS at an early age and sooner rather than later after disease onset may gain more benefit from DBS than those undergoing DBS after the development of fixed skeletal deformities. There is no enough evidence to refuse or support consideration of DBS in patients with previous ablative procedures.
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, California 94305, USA. hbs@stanford.edu
authors.forename: Helen
authors.initials: H
authors.lastname: Bronte-Stewart
authors.forename: Takaomi
authors.initials: T
authors.lastname: Taira
authors.forename: Francesc
authors.initials: F
authors.lastname: Valldeoriola
authors.forename: Marcello
authors.initials: M
authors.lastname: Merello
authors.forename: William J
authors.initials: WJ
authors.lastname: Marks
authors.forename: Alberto
authors.initials: A
authors.lastname: Albanese
authors.forename: Susan
authors.initials: S
authors.lastname: Bressman
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
mesh_terms: D000367:Age Factors; D001921:Brain / Q000473:pathology / Q000502:physiology; D016208:Databases, Factual / Q000706:statistics & numerical data; D046690:Deep Brain Stimulation / Q000379:methods* / Q000592:standards*; D003704:Dementia; D004421:Dystonia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017408:Guidelines as Topic; D006801:Humans; D001523:Mental Disorders