title: Effectiveness of selective peripheral denervation in combination with pallidal deep brain stimulation for the treatment of cervical dystonia.
abstract: BACKGROUND
  Selective peripheral denervation (SPD) and deep brain stimulation of the globus pallidus (GPi-DBS) are available surgical options for patients with medically refractory cervical dystonia (CD). There are few data available concerning whether patients who have unsatisfactory treatment effects after primary surgery benefit from a different type of subsequent surgery. The aim of this study was to assess whether combining these surgical procedures (SPD plus GPi-DBS) was effective in patients with unsatisfactory treatment effects after their initial surgery.
  
  
  METHODS
  Forty-one patients with medically refractory idiopathic CD underwent SPD and/or GPi-DBS. Patients who were dissatisfied with their primary surgery (SPD or GPi DBS) elected to subsequently undergo a different type of surgery. These patients were assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).
  
  
  RESULTS
  SPD alone and GPi-DBS alone were performed in 16 and 21 patients, respectively. Four patients had unsatisfactory treatment effects after the initial surgery and subsequently underwent another type of surgery. Among them, two patients with persistent dystonia after SPD subsequently underwent GPi-DBS, and two other patients who had insufficient treatment effects following GPi-DBS were subsequently treated with SPD. All of these patients experienced sustained improvement from the combined surgical procedures according to the TWSTRS score during a long-term follow-up of 12-90 months.
  
  
  CONCLUSIONS
  Patients with unsatisfactory treatment effects after an SPD or GPi-DBS experienced improvement from subsequently undergoing other types of surgery. Therefore, combined surgical procedures are additional surgical options with good outcomes in the treatment of patients with residual symptoms after their initial surgery.
authors.affiliation: Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, #56 Dongsuro Bupyeong-Gu, Incheon, 403-720, South Korea.
authors.forename: Moonyoung
authors.initials: M
authors.lastname: Chung
authors.forename: Inbo
authors.initials: I
authors.lastname: Han
authors.forename: Sang-Sup
authors.initials: SS
authors.lastname: Chung
authors.forename: Dong-Kyu
authors.initials: DK
authors.lastname: Jang
authors.forename: Ryoong
authors.initials: R
authors.lastname: Huh
mesh_terms: D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009121:Muscle Denervation / Q000379:methods*; D010525:Peripheral Nerves / Q000601:surgery*; D014103:Torticollis / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome