title: Globus pallidus deep brain stimulation for adult-onset axial dystonia.
abstract: BACKGROUND
  Generalized dystonia, both primary and secondary forms, and axial dystonias such as tardive dystonia, and idiopathic cervical dystonia are responsive to globus pallidus interna (GPi) DBS. There is a paucity of investigations probing the impact of DBS on adult-onset axial dystonia. We assessed the efficacy of GPi DBS in four patients with rare adult-onset axial dystonia.
  
  
  METHODS
  Primary outcome measure was improvement in the motor component of the Burke-Fahn-Marsden (BFM) rating scale. Secondary outcome measures were quality of life as determined by the SF-36 questionnaire, time to achieve best possible benefit and DBS parameters that accounted for the best response. In patients with prominent concomitant cervical dystonia we also used the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).
  
  
  RESULTS
  GPi DBS improved BFM scores by 87.63 ± 11.46%. Improvement in total severity scale of TWSTRS was 71.5 ± 12.7%. Quality of life also remarkably improved as evidenced by 109.38 ± 82.97 and 7.05 ± 21.48% percent change in psychometrically-based physical component summary (PCS), and a mental component summary (MCS) score respectively.
  
  
  CONCLUSIONS
  GPi DBS is a very effective treatment for adult-onset axial dystonia. Considering its refractoriness to medical therapy and significant impact on quality of life DBS should be considered for this disorder.
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, USA. Electronic address: aasefshaikh@gmail.com.
authors.forename: Aasef G
authors.initials: AG
authors.lastname: Shaikh
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, USA.
authors.forename: Klaus
authors.initials: K
authors.lastname: Mewes
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Jinnah
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, USA.
authors.forename: Mahlon R
authors.initials: MR
authors.lastname: DeLong
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gross
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, USA.
authors.forename: Shirley
authors.initials: S
authors.lastname: Triche
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Freeman
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, USA.
authors.forename: Stewart A
authors.initials: SA
authors.lastname: Factor
mesh_terms: D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation; D020821:Dystonic Disorders / Q000628:therapy*; D005260:Female; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Basal ganglia; Functional neurosurgery; Movement disorders