title: Selective peripheral denervation for cervical dystonia: long-term follow-up.
abstract: OBJECTIVE
  61 procedures with selective peripheral denervation for cervical dystonia were retrospectively analysed concerning surgical results, pain, quality of life (QoL) and recurrences.
  
  
  METHODS
  The patients were assessed with the Tsui torticollis scale, Visual Analogue Scale (VAS) for pain and Fugl-Meyer scale for QoL. Evaluations were performed preoperatively, early postoperatively, at 6 months, then at a mean of 42 (13-165) months. All patients underwent electromyogram at baseline, which was repeated in cases who presented with recurrence of symptoms after surgery.
  
  
  RESULTS
  Six months of follow-up was available for 55 (90%) of the procedures and late follow-up for 34 (56%). The mean score of the Tsui scale was 10 preoperatively. It improved to 4.5 (p<0.001) at 6 months, and 5.3 (p<0.001) at late follow-up. VAS for pain improved from 6.5 preoperatively to 4.2 (p<0.001) at 6 months and 4 (p<0.01) at late follow-up. The Fugl-Meyer score for QoL improved from 43.3 to 46.6 (p<0.05) at 6 months, and to 51.1 (p<0.05) at late follow-up. Major reinnervation and/or change in the dystonic pattern occurred following 29% of the procedures, and led in 26% of patients to reoperation with either additional denervation or pallidal stimulation.
  
  
  CONCLUSIONS
  Selective peripheral denervation remains a surgical option in the treatment of cervical dystonia when conservative measures fail. Although the majority of patients experience a significant relief of symptoms, there is a substantial risk of reinnervation and/or change in the pattern of the cervical dystonia.
authors.affiliation: Department of Clinical Neuroscience, Section of Neurosurgery, Umeå University, Umeå, Sweden.
authors.forename: A Tommy
authors.initials: AT
authors.lastname: Bergenheim
authors.affiliation: Department of Clinical Neuroscience, Section of Neurophysiology, Umeå University, Umeå, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Nordh
authors.affiliation: Department of Clinical Neuroscience, Section of Neurosurgery, Umeå University, Umeå, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Larsson
authors.affiliation: Department of Clinical Neuroscience, Section of Neurosurgery, Umeå University, Umeå, Sweden UCL Institute of Neurology, London, UK.
authors.forename: Marwan I
authors.initials: MI
authors.lastname: Hariz
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus; D006801:Humans; D008297:Male; D008875:Middle Aged; D009121:Muscle Denervation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D010147:Pain Measurement; D010525:Peripheral Nerves / Q000601:surgery*; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D014103:Torticollis / Q000601:surgery*; D016896:Treatment Outcome
keywords: DYSTONIA; MOVEMENT DISORDERS; NEUROSURGERY