title: Selective peripheral denervation: comparison with pallidal stimulation and literature review.
abstract: Patients with cervical dystonia who are non-responders to Botulinum toxin qualify for surgery. Selective peripheral denervation (Bertrand's procedure, SPD) and deep brain stimulation of the globus pallidus (GPi-DBS) are available surgical options. Although peripheral denervation has potential advantages over DBS, the latter is nowadays more commonly performed. We describe the long-term outcome of selective peripheral denervation as compared with GPi-DBS, along with the findings of literature review. Twenty patients with selective peripheral denervation and 15 with GPi-DBS were included. Tsui scale, a visual analogue scale, and the global outcome score of the Toronto Western Spasmodic Torticollis Rating Scale were used to define a "combined global surgical outcome". The "combined global surgical outcome" for patients with selective peripheral denervation or pallidal stimulation was respectively "bad" for 65 and 13.3 %, "fair-to-good" for 30 and 26.7 %, and "marked" improvement for 5 and 60 % (p < 0.001). Improvement on visual analogue scale (p < 0.002), global outcome score (p < 0.002), and Tsui score (p < 0.000) was larger for the pallidal stimulation group. Seventy-five percent of patients with selective peripheral denervation and 60 % of patients with pallidal stimulation reported side effects. Seven patients with selective peripheral denervation successively underwent GPi-DBS, with a further significant improvement in the Tsui score (-48.6 ± 17.4 %). GPi-DBS is to be preferred to selective peripheral denervation for the treatment of cervical dystonia because it produces larger benefit, even if it can have more potentially severe complications. GPi-DBS is also a valid alternative in case of failure of SPD.
authors.affiliation: Department of Neurology/Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, m.f.contarino@amc.uva.nl.
authors.forename: Maria Fiorella
authors.initials: MF
authors.lastname: Contarino
authors.forename: Pepijn
authors.initials: P
authors.lastname: Van Den Munckhof
authors.forename: Marina A J
authors.initials: MA
authors.lastname: Tijssen
authors.forename: Rob M A
authors.initials: RM
authors.lastname: de Bie
authors.forename: D Andries
authors.initials: DA
authors.lastname: Bosch
authors.forename: P Richard
authors.initials: PR
authors.lastname: Schuurman
authors.forename: Johannes D
authors.initials: JD
authors.lastname: Speelman
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D003627:Data Interpretation, Statistical; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D003714:Denervation; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010525:Peripheral Nerves / Q000601:surgery*; D014103:Torticollis / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A