title: Bilateral subthalamic nucleus stimulation for generalized dystonia after bilateral pallidotomy.
abstract: BACKGROUND
  Thalamotomies and pallidotomies were commonly performed before the deep brain stimulation (DBS) era. Although ablative procedures can lead to significant dystonia improvement, longer periods of analysis reveal disease progression and functional deterioration. Today, the same patients seek additional treatment possibilities.
  
  
  METHODS
  Four patients with generalized dystonia who previously had undergone bilateral pallidotomy came to our service seeking additional treatment because of dystonic symptom progression. Bilateral subthalamic nucleus DBS (B-STN-DBS) was the treatment of choice. The patients were evaluated with the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and the Unified Dystonia Rating Scale (UDRS) before and 2 years after surgery.
  
  
  RESULTS
  All patients showed significant functional improvement, averaging 65.3% in BFMDRS (P = .014) and 69.2% in UDRS (P = .025).
  
  
  CONCLUSIONS
  These results suggest that B-STN-DBS may be an interesting treatment option for generalized dystonia, even for patients who have already undergone bilateral pallidotomy.
authors.affiliation: Division of Functional Neurosurgery, Department of Neurology of School of Medicine of University of São Paulo, São Paulo SP, Brazil. fonoffet@usp.br
authors.forename: Erich Talamoni
authors.initials: ET
authors.lastname: Fonoff
authors.forename: Wuilker Knoner
authors.initials: WK
authors.lastname: Campos
authors.forename: Maurício
authors.initials: M
authors.lastname: Mandel
authors.forename: Eduardo Joaquim Lopes
authors.initials: EJ
authors.lastname: Alho
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D020821:Dystonic Disorders / Q000628:therapy*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D053860:Pallidotomy / Q000379:methods*; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult