title: Treatment of secondary dystonia with a combined stereotactic procedure: long-term surgical outcomes.
abstract: OBJECTIVE
  There is some debate about the effects of pallidal deep brain stimulation (DBS) or lesioning on secondary dystonia. We applied a multimodal method to maximize the treatment effects of deep brain stimulation in patients with secondary dystonia.
  
  
  METHODS
  Between March 2003 and January 2009, four patients underwent bilateral globus pallidus internus (GPi) DBS and six patients underwent bilateral GPi DBS plus unilateral thalamotomy for treatment of cerebral palsy (CP). Among the patients with secondary dystonia without CP, five were also treated by DBS. We classified patients with generalized secondary dystonia with cerebral palsy into group I and patients with focal dystonia without CP into group II. Clinical outcome assessments were based on Burke-Fahn-Marsden Dystonia Rating Scale movement and disability scores. Heath-related quality of life was assessed with a 36-item short-form general health survey questionnaire preoperatively and at the last follow-up.
  
  
  RESULTS
  The movement and disability scores of group I-A had improved by 32.0% (P = 0.285) and 14.3% (P = 0.593), respectively, at the last follow-up compared with baseline. The movement and disability scores of group I-B had improved by 31.5% and 0.18% at the last follow-up compared with baseline, respectively. In comparison with patients in group I-A, patients in group I-B showed a significant improvement in movement scores for the contralateral arm (P = 0.042). Group II patients showed a marked improvement in movement and disability scores of 77.7% (P = 0.039) and 80.0% (P = 0.041), respectively.
  
  
  CONCLUSIONS
  We demonstrated that DBS plus unilateral ventralis oralis thalamotomy for CP patients with fixed states in the upper extremities is useful not only to treat secondary dystonic movement but also to improve quality of life. In group II patients with post-traumatic dystonia and tardive dyskinesia, we achieved excellent clinical outcomes using a stereotactic procedure.
authors: Department of Neurosurgery, Severance Hospital, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemoon-Gu 120-752, Seoul, Korea.
authors: Joo Pyung
authors: JP
authors: Kim
authors: Won Seok
authors: WS
authors: Chang
authors: Jin Woo
authors: JW
authors: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods*; D046690:Deep Brain Stimulation / Q000379:methods*; D020821:Dystonic Disorders / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013997:Time Factors; D055815:Young Adult